来自不同风险群体的HIV阴性个体的最佳HIV筛查和检测间隔的证据:一项系统综述。

K. Timmerman, M. Weekes, G. Traversy, P. Prabakhar, T. Austin, S. Ha, B. Anwar
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引用次数: 1

摘要

人体免疫缺陷病毒(艾滋病毒)检测在加拿大的艾滋病毒预防和治疗工作中起着至关重要的作用,是实现联合国艾滋病毒/艾滋病联合规划署(艾滋病规划署)90-90-90目标的第一步;然而,加拿大人,包括艾滋病毒暴露风险增加的人群,应该多久进行一次检测尚不清楚。我们进行了系统的文献综述,以确定最佳的HIV筛查和检测间隔。目的探讨不同高危人群HIV阴性个体HIV检测间隔的现有证据,评估不同检测频率的潜在危害及患者的价值观和偏好。方法检索MEDLINE/PubMed、Scopus、Embase、Cochrane Library、PsychINFO和EconLit,检索2000年1月至2016年9月发表的不同HIV检测频率的研究。对2000年1月至2016年10月间发表的灰色文献进行了额外的搜索。数据提取包括研究特征、参与者、暴露、结果和经济变量。评估研究的质量并总结研究结果。结果在检索到的2702篇文章中,有27篇符合纳入标准。这包括对普通人群、男男性行为者、注射吸毒者和性工作者的艾滋病毒检测间隔进行评估。跨风险组的最佳检测间隔从一次检测到每三个月检测一次。来自模拟研究的数据可能不能代表加拿大的情况。很少有研究发现增加筛查的潜在危害,特别是假阳性和假阴性结果的增加。只有两项研究涉及患者对艾滋病毒筛查的价值观和偏好,这表明大多数参与者都可以通过初级保健提供者进行常规筛查。结论没有足够的证据支持不同人群的最佳HIV筛查和检测间隔。具体情况因素,如预算分配、人力资源、当地流行病学、社会经济因素和风险行为,以及临床判断,告知筛查的对象和频率,表明需要针对加拿大进行研究。研究患者的偏好以及更频繁的筛查的好处和危害也指出。
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Evidence for optimal HIV screening and testing intervals in HIV-negative individuals from various risk groups: A systematic review.
Background Human immunodeficiency virus (HIV) testing plays a crucial role in Canada's HIV prevention and treatment efforts and is the first step to achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets; however, how often Canadians, including populations at increased risk of HIV exposure, should be tested is unclear. We conducted a systematic literature review to determine the optimal HIV screening and testing intervals. Objective To examine the current evidence on HIV testing intervals in HIV-negative individuals from various risk groups and to assess the potential harms and patients' values and preferences associated with different testing frequencies. Methods We searched MEDLINE/PubMed, Scopus, Embase, the Cochrane Library, PsychINFO and EconLit for studies on different frequencies of HIV testing published between January 2000 and September 2016. An additional search was conducted for grey literature published between January 2000 and October 2016. Data extraction included study characteristics, participants, exposure, outcomes and economic variables. The quality of the studies was assessed and results summarized. Results Of the 2,702 articles identified from the searches, 27 met the inclusion criteria for review. This included assessments of HIV testing intervals among the general population, men who have sex with men, people who use injection drugs and sex workers. Optimal testing intervals across risk groups ranged from one-time testing to every three months. Data from modelling studies may not be representative of the Canadian context. Few studies identified potential harms of increased screening, specifically an increase in both false positive and false negative results. There were only two studies that addressed patient values and preferences concerning HIV screening, which suggested that the majority of participants were amenable to routine screening through their primary care provider. Conclusion There was insufficient evidence to support optimal HIV screening and testing intervals for different populations. Context-specific factors, such as budget allocation, human resources, local epidemiology, socioeconomic factors and risk behaviours, along with clinical judgement, inform whom and how often to screen, suggesting the need for research specific to Canada. Research on patient preferences as well as the benefits and harms of more frequent screening are also indicated.
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