Increasing Viral Testing in the Emergency Department (InVITED)

增加急诊室的病毒检测 (InVITED)

• 批准号: 8035968
• 负责人: Roland C Merchant
• 金额: $ 17.11万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-03-01 至 2012-09-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8035968
• 关键词: Accident and Emergency department; Address; Adult; Amphetamines; Benzodiazepines; Biopsy; Caring; Categories; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinical; Data; Diagnostic tests; Drug usage; Drug user; Effectiveness; Ensure; Evaluation; Future; Goals; HIV; HIV Infections; Health Services Accessibility; Hepatitis B; Hepatitis B Vaccination; Hepatitis C; High Prevalence; Hospitals; Hour; Immune; Infection; Injecting drug user; Injection of therapeutic agent; Intervention; Intervention Studies; Laboratories; Learning; Left; Length of Stay; Link; Measurement; Measures; Medical; Methods; Opioid; Outcome Measure; Outcomes Research; Participant; Patient Self-Report; Patients; Pharmaceutical Preparations; Population; Prevalence; Process; Process Measure; Published Comment; Randomized; Randomized Controlled Trials; Readiness; Recommendation; Reporting; Research; Risk; Risk Assessment; Risk Behaviors; Screening procedure; Secure; Self-Administered; Services; Severities; Severity of illness; Shapes; Simulate; Source; Staging; System; Test Result; Testing; Time; Time Study; Viral; Viral Load result; Viral Markers; Virus; Virus Diseases; Visit; Work; addiction; arm; base; brief intervention; disorder prevention; drug abuser; experience; follow-up; improved; indexing; innovation; medical specialties; point of care; primary outcome; public health relevance; satisfaction; uptake; vaccination strategy; willingness; Accident and Emergency department; Address; Adult; Amphetamines; Benzodiazepines; Biopsy; Caring; Categories; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinical; Data; Diagnostic tests; Drug usage; Drug user; Effectiveness; Ensure; Evaluation; Future; Goals; HIV; HIV Infections; Health Services Accessibility; Hepatitis B; Hepatitis B Vaccination; Hepatitis C; High Prevalence; Hospitals; Hour; Immune; Infection; Injecting drug user; Injection of therapeutic agent; Intervention; Intervention Studies; Laboratories; Learning; Left; Length of Stay; Link; Measurement; Measures; Medical; Methods; Opioid; Outcome Measure; Outcomes Research; Participant; Patient Self-Report; Patients; Pharmaceutical Preparations; Population; Prevalence; Process; Process Measure; Published Comment; Randomized; Randomized Controlled Trials; Readiness; Recommendation; Reporting; Research; Risk; Risk Assessment; Risk Behaviors; Screening procedure; Secure; Self-Administered; Services; Severities; Severity of illness; Shapes; Simulate; Source; Staging; System; Test Result; Testing; Time; Time Study; Viral; Viral Load result; Viral Markers; Virus; Virus Diseases; Visit; Work; addiction; arm; base; brief intervention; disorder prevention; drug abuser; experience; follow-up; improved; indexing; innovation; medical specialties; point of care; primary outcome; public health relevance; satisfaction; uptake; vaccination strategy; willingness

DESCRIPTION (provided by applicant): Emergency departments (EDs) could potentially provide combined rapid screening for HIV, hepatitis B, and hepatitis C to those who misuse drugs and serve as a conduit to needed primary and specialty medical care. Point-of-care rapid screening is available for HIV, but not yet for hepatitis B/C. However, The Miriam Hospital clinical laboratory can perform conventional hepatitis B/C testing in a "rapid" manner (less than one hour) using automated systems during weekday regular working hours. In this innovative R21 study, Increasing Viral Testing in the ED (InVITED), we will seize upon this unique chance to perform simulated point-of- care rapid hepatitis B/C screening. In addition, we will perform true rapid HIV screening in anticipation of the future availability of true rapid screening for all three infections among ED patients who misuse drugs. The primary outcome measured in InVITED is uptake of screening (i.e., willingness to be tested) for all three of these infections by ED patients who misuse drugs. We also will investigate a number of process measures commensurate with this early stage research. These measures will help determine if combined screening for HIV and hepatitis B/C among all ED patients who misuse drugs is a worthwhile pursuit, even among ED patients who are not injection-drug users. As part of InVITED, we will conduct a randomized, controlled trial to investigate if a brief intervention (BI) along with a risk assessment about HIV and hepatitis B/C risk behaviors increases uptake of combined screening for HIV and hepatitis B/C, compared to a risk assessment alone. If BI and a risk assessment are more effective than a risk assessment alone in increasing uptake of screening in InVITED, then we can further develop and refine the BI methods in future larger research endeavors. In the secondary aims of this R21 early-stage research, we will consider several process and supportive measures to evaluate the screening experience, yield of combined screening in the ED, and the BI provided to participants. We will: (1) investigate factors influencing uptake of HIV and hepatitis B/C screening; (2) examine the impact of a BI on self-recognition for and readiness to be screened; (3) learn the prevalence of unrecognized HIV and hepatitis B/C infections in this population; (4) understand the need for and uptake of hepatitis B vaccination in this population; (5) quantify the viral load and disease severity among those with HIV and hepatitis B/C; (6) evaluate the provision of screening for these infections in the ED; and (7) understand the subjective experience of the BI. We also will demonstrate a system of linking patients with these infections directly into medical care. PUBLIC HEALTH RELEVANCE: The emergency department could serve as an important venue for identifying unrecognized HIV, hepatitis B, and hepatitis C infections among drug misusers through combined rapid screening. A brief intervention to increase uptake of combined screening might further boost identification of unrecognized infections and enhance linkage to care.

描述（由申请人提供）：急诊科（EDS）可能会向那些滥用毒品的人提供艾滋病毒，乙型肝炎和丙型肝炎的快速筛查，并用作需要初级和专业医疗服务的渠道。护理快速筛查可用于HIV，但尚未用于乙型肝炎。但是，Miriam医院临床实验室可以在工作日的常规工作时间内使用自动化系统以“快速”的方式（少于一小时）进行常规的丙型肝炎测试。在这项创新的R21研究中，在ED中增加了病毒测试（受邀），我们将抓住这一独特的机会来进行模拟的快速肝炎B/C筛查。此外，我们将在滥用药物的ED患者中对所有三种感染的真正快速筛查的未来可用性进行真正的快速艾滋病毒筛查。 在被邀请的邀请中测得的主要结果是吸收滥用药物的ED患者对所有这三种感染的筛查（即愿意测试的意愿）。我们还将研究与这项早期研究相称的许多过程度量。这些措施将有助于确定所有滥用药物的ED患者中的HIV和乙型肝炎的联合筛查是值得追求的，即使在不是注射药物使用者的ED患者中。 作为受邀的一部分，我们将进行一项随机，对照的试验，以调查是否进行简短干预（BI）以及对HIV和乙型肝炎的风险评估，与单独的风险评估相比，对HIV和HIV和肝炎B/C的合并筛查的吸收增加。如果BI和风险评估比单独的风险评估更有效地在受邀筛查中增加了筛查，那么我们可以进一步开发和完善未来更大的研究努力中的BI方法。 在这项R21早期研究的次要目标中，我们将考虑几种过程和支持措施，以评估筛查经验，ED中的联合筛选产量以及提供给参与者的BI。我们将：（1）研究影响HIV摄取和肝炎B/C筛查的因素； （2）检查BI对要筛选的自我认识和准备就绪的影响； （3）了解该人群中未识别的HIV和B/C感染的患病率； （4）了解该人群中对乙型肝炎疫苗接种的需求； （5）量化HIV和肝炎B/C的病毒负荷和疾病严重程度； （6）评估ED中这些感染的筛查提供； （7）了解BI的主观体验。我们还将展示一种将这些感染的患者直接连接到医疗服务的系统。 公共卫生相关性：急诊科可以通过迅速筛查中识别未识别的艾滋病毒，乙型肝炎和丙型肝炎感染的重要场所。简短的干预措施以增加对筛查的摄取，可能会进一步促进未知的感染并增强与护理的联系。