Rapid Point Of Care Test Research Articles

The \u201cPetechiae in children\u201d (PiC) study: evaluating potential clinical decision rules for the management of feverish children with non-blanching rashes, including the role of point of care testing for Procalcitonin & Neisseria meningitidis DNA \u2013 a study protocol

BackgroundChildren commonly present to Emergency Departments (ED) with a non-blanching rash in the context of a feverish illness. While most have a self-limiting viral illness, this combination of features potentially represents invasive serious bacterial infection, including meningococcal septicaemia. A paucity of definitive diagnostic testing creates diagnostic uncertainty for clinicians; a safe approach mandates children without invasive disease are often admitted and treated with broad-spectrum antibiotics. Conversely, a cohort of children still experience significant mortality and morbidity due to late diagnosis. Current management is based on evidence which predates (i) the introduction of meningococcal B and C vaccines and (ii) availability of point of care testing (POCT) for procalcitonin (PCT) and Neisseria meningitidis DNA.MethodsThis PiC study is a prospective diagnostic accuracy study evaluating (i) rapid POCT for PCT and N. meningitidis DNA and (ii) performance of existing clinical practice guidelines (CPG) for feverish children with non-blanching rash. All children presenting to the ED with a history of fever and non-blanching rash are eligible. Children are managed as normal, with detailed prospective collection of data pertinent to CPGs, and a throat swab and blood used for rapid POCT. The study is running over 2 years and aims to recruit 300 children.Primary objective:Report on the diagnostic accuracy of POCT for (i) N. meningitidis DNA and (ii) PCT in the diagnosis of early MDReport on the diagnostic accuracy of POCT for PCT in the diagnosis of Invasive bacterial infectionSecondary objectives:Evaluate the performance accuracy of existing CPGsEvaluate cost-effectiveness of available diagnostic testing strategiesExplore views of (i) families and (ii) clinicians on research without prior consent using qualitative methodologyReport on the aetiology of NBRs in children with a feverish illnessDiscussionThe PiC study will provide important information for policy makers regarding the value of POCT and on the utility and cost of emerging diagnostic strategies. The study will also identify which elements of existing CPGs may merit inclusion in any future study to derive clinical decision rules for this population.Trial registrationNCT03378258. Retrospectively registered on December 19, 2017.

Point of care rapid test for diagnosis of syphilis infection in pregnant women

Point of care rapid test for diagnosis of syphilis infection in pregnant women

Point of care rapid test for diagnosis of syphilis infection in men and nonpregnant women

Point of care rapid test for diagnosis of syphilis infection in men and nonpregnant women

Impact of a multiplex PCR point-of-care test for influenza A/B and respiratory syncytial virus on an acute pediatric hospital ward

Patients with respiratory infections are often managed presumptively until confirmation of infection status. We assessed the impact of introducing the Enigma® MiniLab™ FluAB-RSV point-of-care test (POCT) on patients admitted with a suspected respiratory virus driven illness in an acute pediatric ward. This utilized a before and after design (respiratory viral seasons 2013/14 versus 2014/15). Following POCT implementation, oseltamivir prescribing increased in patients with influenza (OR = 12.7, P = 0.05, 95% CI [1.0, 153.8]). A reduction in the average reimbursement charges without a change in the length of stay was observed. Modeling suggested that laboratory test cost savings could be achieved if the POCT cost £30 and was used for screening, followed by the respiratory viral panel for RSV and influenza negative patients. A rapid POCT for influenza A/B and RSV infections in pediatric inpatients may improve oseltamivir prescribing, strengthen antimicrobial stewardship, reduce reimbursement charges and decrease laboratory costs.

HIV testing in a South African Emergency Department: A missed opportunity.

BackgroundSouth Africa has the largest HIV epidemic in the world, with 19% of the global number of people living with HIV, 15% of new infections and 11% of AIDS-related deaths. Even though HIV testing is mandated in all hospital-based facilities in South Africa (SA), it is rarely implemented in the Emergency Department (ED). The ED provides episodic care to large volumes of undifferentiated who present with unplanned injury or illness. Thus, the ED may provide an opportunity to capture patients with undiagnosed HIV infection missed by clinic-based screening programs.Methods and findingsIn this prospective exploratory study, we implemented the National South African HIV testing guidelines (counselor initiated non-targeted universal screening with rapid point of care testing) for 24-hours a day at Frere Hospital in the Eastern Cape from September 1st to November 30th, 2016. The purpose of our study was to quantify the burden of undiagnosed HIV infection in a South African ED setting. Furthermore, we sought to evaluate the effectiveness of the nationally recommended HIV testing strategy in the ED. All patients who presented for care in the ED during the study period, and who were clinically stable and fully conscious, were eligible to be approached by HIV counseling and testing (HCT) staff to receive a rapid point-of-care HIV test. A total of 2355 of the 9583 (24.6%) patients who presented to the ED for care during the study period were approached by the HCT staff, of whom 1714 (72.8%) accepted HIV testing. There was a high uptake of HIV testing (78.6%) among a predominantly male (58%) patient group who mostly presented with traumatic injuries (70.8%). Four hundred (21.6%) patients were HIV positive, including 115 (6.2%) with newly diagnosed HIV infection. The overall prevalence of HIV infection was twice as high in females (29.8%) compared to males (15.4%). Both sexes had a similar prevalence of newly diagnosed HIV infection (6.0% for all females and 6.4% for all males) in the ED.ConclusionsOverall there was high HIV testing acceptance by ED patients. A non-targeted testing approached revealed a high HIV prevalence with a significant burden of undiagnosed HIV infection in the ED. Unfortunately, a counselor-driven HIV testing approach fell short of meeting the testing needs in this setting, with over 75% of ED patients not approached by HCT staff.

Adaptation of POCT for pharmacies to reduce risk and optimize access to care in HIV, the APPROACH study protocol: examining acceptability and feasibility

BackgroundApproximately 1 in 5 Canadians with HIV are unaware of their status. In many provinces and especially rural communities, barriers to HIV testing include lack of access, privacy concerns, and stigma. The availability of HIV point-of-care testing (POCT) is limited across Canada. Pharmacists are well positioned to address barriers by offering rapid HIV POCT and facilitating linkage to care.MethodsWe will use a type-2 hybrid implementation-effectiveness design to assess a pilot HIV POCT model in one urban and one rural pharmacy in each of two Canadian provinces over 6 months. In this feasibility trial the research aims include developing and assisting pharmacies in implementing the model, evaluating processes/determinants of program implementation, evaluating the model’s effects on client outcomes, preferences, and testing satisfaction. Using a community-based research approach, the research team will engage community stakeholders in each province including individuals with lived experience to inform the development of the pharmacy-based HIV testing model and support the research team throughout the study. A multipronged promotion campaign will be used to promote the study and facilitate recruitment. The pharmacy-based testing model will include pre/post-test counseling and linkage to care plans in addition to pharmacist-administered HIV POCT. Pharmacists will complete a comprehensive training program prior to implementing the testing model. Client demographics and satisfaction will be assessed by surveys and interviews. Pharmacists will document time required for testing and participate in a post-study focus group to discuss barriers/enablers. Implementation will be assessed qualitatively and quantitatively. The process of developing and implementing the model will be described using qualitative data and a logic model. Acceptability and barriers/enablers will be examined qualitatively based on survey responses. A preliminary costing assessment will consider the client, pharmacy, and government perspectives.DiscussionThe results of this pilot will inform modifications to the HIV POCT model to optimize effectiveness and increase scalability. The study has national importance, providing valuable information on improving access to HIV testing. Future applications of this research may expand the role of pharmacists in offering POCT for other sexually transmitted/bloodborne infections as tests become available in Canada.Trial registrationClinicaltrials.gov, NCT03210701

Rollout of rapid point of care tests for antenatal syphilis screening in Ghana: healthcare provider perspectives and experiences

BackgroundEffective implementation of rapid point of care tests (POCTs) for antenatal syphilis screening especially in settings where antenatal care attendance is high, can significantly increase screening coverage and treatment uptake. The operational challenges of introducing rapid syphilis POCTs at scale needs to be investigated. This study explores healthcare providers’ experiences and challenges in antenatal syphilis screening following the national rollout of rapid syphilis POCTs in Ghana.MethodsPrior to the main study, we undertook a desk review of key syphilis policy documents, and conducted key stakeholder interviews and a baseline survey of syphilis screening practices. Antenatal syphilis screening had been poorly implemented mainly due to inadequate technical and logistic support, and lack of monitoring and supervision. For the main research, semi-structured interviews were conducted with 51 purposively selected healthcare staff involved in antenatal syphilis screening in 15 health facilities in three regions, representative of all levels of healthcare in Ghana and two regional programme coordinators, at least four months after the rollout. The interviews were supplemented with an audit of the conduct of antenatal care, syphilis-related supplies and other maternal and newborn interventions. Qualitative data were coded and analysed using Nvivo software.ResultsSyphilis screening with rapid POCTs was integrated into antenatal care in almost all (13/15) the facilities surveyed. Testing and treatment were offered free of charge to pregnant women, their partners and babies. In most facilities, midwives were performing syphilis tests together with HIV tests. Operational challenges included: inadequate training and lack of refresher training, lack of clear testing guidelines, clear channels of communication, supervision, and guidance on treatment and referral procedures, frequent stockouts of, or expired test kits, staff overload, and poor documentation of test results and treatment.ConclusionAlthough syphilis screening with rapid syphilis POCTs was integrated into antenatal care, key challenges, particularly around supply chain and supervision, need to be addressed to improve and sustain such a programme.

Rapid diagnostic test for antenatal syphilis screening in low-income and middle-income countries: a systematic review and meta-analysis

ObjectivesTo undertake a systematic review and meta-analysis to evaluate the test performance including sensitivity and specificity of rapid immunochromatographic syphilis (ICS) point-of-care (POC) tests at antenatal clinics compared with reference...

Point-of-care screening for hepatitis B virus infection in pregnant women at an antenatal clinic: A South African experience.

Background & aimsElimination of HIV and syphilis mother-to-child transmission (MTCT) has received much attention but little consideration has been given to the possibility of elimination of HBV MTCT. In sub-Saharan Africa, HBV vertical transmission continues to be reported and it remains an important public health problem. This study aimed to assess the feasibility of screening pregnant women for HBV using a point-of-care (POC) test and implementing interventions to prevent HBV MTCT.MethodsIn this observational prospective cohort study, HIV-uninfected pregnant women who consented to testing were screened for HBV using a rapid POC test for HBsAg. Positive results were laboratory-confirmed and tested for HBV DNA and serological markers. Women with viral loads ≥ 20 000 IU/ml received tenofovir (TDF) treatment and all infants received birth-dose HBV vaccine. Two blood samples collected six months apart from HBV-exposed infants within their first year of life were tested for HBV DNA.ResultsOf 144 women who were approached, 134 consented to participating (93% acceptance rate of HBV POC test). Six women tested positive for HBsAg (4.5%; 95% CI 0.99%–8.01%), all confirmed by laboratory testing. Two mothers, M1 and M4, were treated with TDF during their third trimester of pregnancy. Six HBV-exposed infants received the HBV vaccine within 24 hours of birth, of whom two were lost to follow-up and four (including the two born to M1 and M4) had undetectable levels of HBV DNA when tested at the two time points.ConclusionWe found that HBV screening using POC testing fulfilled the criteria considered necessary for implementation. It has acceptable performance, is inexpensive, reliable, and was well accepted by the study participants. Screening pregnant women as part of the HBV MTCT prevention strategy is therefore feasible in a South African clinical setting.

Pharmacists performing hepatitis C antibody point-of-care screening in a community pharmacy: A pilot project

ObjectivesTo describe the first community pharmacy–based hepatitis C antibody (HCV-Ab) point-of-care (POC) screening program and its outcomes in California. SettingCommunity pharmacy. Practice descriptionCommunity pharmacists perform HCV-Ab POC testing, counsel patients about HCV transmission and prevention, and provide linkage to care. Practice innovationPharmacists implement an HCV-Ab POC screening program in collaboration with the local public health department. EvaluationDescriptive data of the demographics of the persons receiving HCV-Ab POC screening and qualitative assessment of the attitudes and knowledge of the trained pharmacists involved in its implementation. ResultsDuring the 3-month pilot, 6 community pharmacists performed 83 HCV-Ab rapid POC tests with 1 positive result (1.2%). Risk factors for the positive result included injection drug use, crack cocaine or methamphetamine use, and being in the high-risk birth cohort. Although some expressed reservations, pharmacists attested to the feasibility of incorporating HCV screening into their routine pharmacy work. Two major barriers identified by pharmacists for implementing HCV screening included getting non-pharmacy customers into the pharmacy for testing and balancing the time required to review test results within the normal pharmacy workflow. ConclusionThis pilot demonstrated that trained and motivated community pharmacists in partnership with the Department of Public Health could perform needed rapid HCV-Ab POC screening for potentially high-risk patients not currently in care. Community pharmacies are viable locations for screening and linkage to care owing to their easy access to knowledgeable pharmacists and accessible locations.

Comparison of the Alere i and BD Veritor Assays for the Rapid Detection of Influenza A and B Viruses.

The use of point-of care testing (POCT) in patient management decisions is becoming increasingly common. Our goal was to evaluate the diagnostic performance of 2 commercially available rapid POCT devices for influenza viruses A and B: the Alere™ i Instrument (Alere, Scarborough) and the BD Veritor™ System (BD Diagnostics). Paired nasopharyngeal swabs were collected from patients (18-71 years) presenting with influenza-like symptoms at 3 outpatient clinics. A total of 65 samples were obtained. The Alere i and BD Veritor were performed according to the manufacturers' instructions. Discordant results were resolved using real-time reverse transcription PCR (RT-PCR). In a head-to-head comparison involving symptomatic adult patients visiting outpatient clinics during the 2014-2015 and 2015-2016 influenza seasons, the Alere i and BD Veritor had 90.63% agreement in the detection of influenza A virus and a statistically significant observed κ coefficient of 0.754 (P <0.0001). Discordant results between the Alere i and BD Veritor were further investigated using RT-PCR, showing that the BD Veritor missed 5 positive influenza A virus results (false negatives) and detected 1 false positive, while the Alere i results agreed with all RT-PCR results. There were no discordant results between the Alere i and BD Veritor in the detection of influenza B virus. Our data suggest that the Alere i has higher sensitivity and specificity than the BD Veritor in the detection of influenza A virus. Both assays showed equal performance in the detection of influenza B virus.

P283 Quantum blue® adalimumab: development of the first point of care rapid test for therapeutic drug monitoring of serum adalimumab levels

P283 Quantum blue® adalimumab: development of the first point of care rapid test for therapeutic drug monitoring of serum adalimumab levels

Acute HIV Infection: Advances in Mechanisms and Prophylactic Therapeutic Management.

Human infection by HIV is spreading rapidly. The spread of the virus is generally organized and transmission can be rectal, oral, or penile. Several types of cells are susceptible to viral invasion. The appearance of symptoms during infection can vary, but the presence of the virus can be confirmed by testing for the antigen p24. The ELISA test is used to detect viral p24 antigen and antiviral antibodies. This technique is approved for the purposes of clinical practice. Highly active antiretroviral therapy is usually a costly and lengthy treatment for HIV infection. A rapid point of care test has also been developed to detect acute infection. There is a need for preventing HIV infection and improving antiretroviral therapy. The treatment regime currently constitutes drugs that have the capability to concentrate in the genital tract of both males and females, as well as the use of integrase inhibitors that rapidly reduce viral load.

388 Implementation of an Emergency Department Syphilis and HIV Point-of-Care Screening Process During an Outbreak of Syphilis in Detroit, MI in Collaboration With the Infectious Disease Department and the Centers for Disease Control and Prevention

The number of primary and secondary syphilis cases in Detroit, Michigan increased from 73 in 2010 to 199 to 2013. Cases were predominantly in young African American men with who have sex with men and with had a high rate of HIV co-infection. The infectious disease (ID) department at Henry Ford Hospital (HFH), in collaboration with the Centers for Disease Control and Prevention (CDC) determined the emergency department (ED) would be the optimal setting to implement a screening program. Young men in Detroit are typically non-health care seeking; however, EDs are venues they do frequent when they access the health care system. We hypothesized that the implementation of an ED screening model would detect an increased number of syphilis and HIV cases than were seen with standard care. Point-of-care (POC) testing would allow presumptive treatment of active syphilis cases in the emergency department, whereas traditional testing would not typically result and allow for care within a typical ED visit time frame. Syphilis and HIV screening was offered to men aged 18-34 years seen in the HFH ED with an Emergency Severity Index (ESI) of 2-5. Dedicated, non-ED staff employed 2 rapid finger-stick POC tests: the Alere Determine HIV-1/2 Ag/ab Combo test (Determine) and the Syphilis Heath Check (SHC) treponemal tests. Participants also underwent venipuncture for standard lab-based testing for HIV and syphilis. Screening took place from 7:30am to 5pm, Monday through Friday. Patients were first approached by screeners, typically before the initial clinician contact and were offered screening. Confirmatory lab-based testing using the Biorad 4th generation HIV test, RPR, and TPPA tests were drawn in conjunction with ED nursing staff during their routine bloodwork. ED clinicians were notified of positive SHC POC testing and patients were treated presumptively in the ED. From 6/10/2015 to 3/11/2016, 871 patients were enrolled. Active syphilis (RPR + TPPA +) was identified in 6 (0.7%) participants, and newly diagnosed HIV in 7 (0.8%). There was one case of syphilis-HIV coinfection, and the combined prevalence was 1.4%. Three patients were treated in the ED for syphilis based on their POC testing results without treatment complications. The implementation of an ED syphilis and HIV POC screening program is a feasible method to detect new cases of disease. The screening process can be incorporated into ED patient flow and provide clinicians with immediate test results to determine the need for treatment. POC HIV and syphilis testing are particularly important to ED providers, who may not otherwise receive important test results for their patients before they leave the emergency department.

Clinical and Laboratory Evaluation of a New Specific Point-of-Care Test for Intact Proinsulin.

Intact proinsulin is a biomarker for pancreatic ß-cell dysfunction. In large prospective studies in nondiabetic subjects, elevated intact proinsulin predicted development of type 2 diabetes and/or macrovascular events up to 7 years in advance. This study was performed to evaluate a new semiquantitative lateral flow-based point-of-care rapid test (POCT) for elevated intact proinsulin (cutoff: 15 pmol/L). The test requires 10 µL of capillary whole blood, with visual readout after 5 minutes. It is best applied at 2 hours after a glucose challenge or a meal. POCT results were obtained by health care professionals from 60 patients and healthy subject (33 female, 27 male, 28 type 2 diabetes, age: 53.6 ± 12.3 years). An additional venous blood sample was obtained from all participants for measurement of intact proinsulin by means of a quantitative ELISA reference method (TecoMedical, Sissach, Switzerland). Elevated intact proinsulin levels (>15 pmol/L) were determined by the reference method in 26 participants, of whom 22 were also positive with the POCT (sensitivity: 85%). All 34 subjects with low intact proinsulin levels were tested negative by the POCT (specificity: 100%). The test successfully detected elevated postprandial intact proinsulin levels in 85% of the tested subjects and no false positive test result occurred. This POCT can therefore serve as a simple screening tool for identification of patients with prevalent ß-cell dysfunction, who are at high risk for development of type 2 diabetes and/or macrovascular events within the next 5-7 years.

Tourniquet Test for Dengue Diagnosis: Systematic Review and Meta-analysis of Diagnostic Test Accuracy.

BackgroundDengue fever is a ubiquitous arboviral infection in tropical and sub-tropical regions, whose incidence has increased over recent decades. In the absence of a rapid point of care test, the clinical diagnosis of dengue is complex. The World Health Organisation has outlined diagnostic criteria for making the diagnosis of dengue infection, which includes the use of the tourniquet test (TT).PurposeTo assess the quality of the evidence supporting the use of the TT and perform a diagnostic accuracy meta-analysis comparing the TT to antibody response measured by ELISA.Data SourcesA comprehensive literature search was conducted in the following databases to April, 2016: MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, BIOSIS, Web of Science, SCOPUS.Study SelectionStudies comparing the diagnostic accuracy of the tourniquet test with ELISA for the diagnosis of dengue were included.Data ExtractionTwo independent authors extracted data using a standardized form.Data SynthesisA total of 16 studies with 28,739 participants were included in the meta-analysis. Pooled sensitivity for dengue diagnosis by TT was 58% (95% Confidence Interval (CI), 43%-71%) and the specificity was 71% (95% CI, 60%-80%). In the subgroup analysis sensitivity for non-severe dengue diagnosis was 55% (95% CI, 52%-59%) and the specificity was 63% (95% CI, 60%-66%), whilst sensitivity for dengue hemorrhagic fever diagnosis was 62% (95% CI, 53%-71%) and the specificity was 60% (95% CI, 48%-70%). Receiver-operator characteristics demonstrated a test accuracy (AUC) of 0.70 (95% CI, 0.66–0.74).ConclusionThe tourniquet test is widely used in resource poor settings despite currently available evidence demonstrating only a marginal benefit in making a diagnosis of dengue infection alone.RegistrationThe protocol for this systematic review was registered at PROSPERO: CRD42015020323.

Rapid Antigen Testing for Trichomoniasis in an Emergency Department.

Trichomoniasis is a prevalent cause of vaginitis among adolescents that increases the risk of acquiring other sexually transmitted diseases and of negative pregnancy outcomes. Treatment of trichomoniasis is therefore essential for improving sexual and reproductive health outcomes. A timely, sensitive diagnostic test for T vaginalis may increase the accuracy of clinician's treatment decisions, resulting in more infected women receiving treatment and fewer uninfected women receiving treatment. This study was a retrospective observational assessment of electronic medical records before and after point-of-care (POC) implementation of the rapid antigen test. Records were collected from women aged 14 to 20 years who received a T vaginalis test in the emergency department during either study period. The main outcome measures were rates of accurate treatment, inaccurate treatment, and missed treatment of trichomoniasis in each study period. Overall rates of accurate treatment increased from 78.7% pre-POC to 87.7% post-POC (P = .02). Specifically, rates of not treating uninfected women increased from 61.4% pre-POC to 70.4% post-POC (P = .06), and rates of treating infected women were the same pre-POC (17.3%) and post-POC (17.3%; P = .99). Rates of inaccurate treatment decreased from 23.1% pre-POC to 13.1% post-POC (P = .02). Changes in missed treatment rates (14.0% pre-POC; 8.8% post-POC; P = .73) were not statistically significant. POC testing can improve clinical care by decreasing the use of antibiotics in uninfected women. The results of this study support the use of a T vaginalis rapid antigen POC test for adolescents presenting to the emergency department.

Using a geographic information system to enhance patient access to point-of-care diagnostics in a limited-resource setting.

BackgroundRapid and accurate diagnosis drives evidence-based care in health. Point-of-care testing (POCT) aids diagnosis by bringing advanced technologies closer to patients. Health small-world networks are constrained by natural connectivity in the interactions between geography of resources and social forces. Using a geographic information system (GIS) we can understand how populations utilize their health networks, visualize their inefficiencies, and compare alternatives.MethodsThis project focuses on cardiac care resource in rural Isaan, Thailand. A health care access analysis was created using ArcGIS Network Analyst 10.1 from data representing aggregated population, roads, health resource facilities, and diagnostic technologies. The analysis quantified cardiac health care access and identified ways to improve it using both widespread and resource-limited strategies.ResultsResults indicated that having diagnostic technologies closer to populations streamlines critical care paths. GIS allowed us to compare the effectiveness of the implementation strategies and put into perspective the benefits of adopting rapid POCT within health networks.ConclusionsGeospatial analyses derive high impact by improving alternative diagnostic placement strategies in limited-resource settings and by revealing deficiencies in health care access pathways. Additionally, the GIS provides a platform for comparing relative costs, assessing benefits, and improving outcomes. This approach can be implemented effectively by health ministries seeking to enhance cardiac care despite limited resources.

Cost-effectiveness analysis of antiviral treatment in the management of seasonal influenza A: point-of-care rapid test versus clinical judgment.

A point-of-care rapid test (POCRT) may help early and targeted use of antiviral drugs for the management of influenza A infection. (i) To determine whether antiviral treatment based on a POCRT for influenza A is cost-effective and, (ii) to determine the thresholds of key test parameters (sensitivity, specificity and cost) at which a POCRT based-strategy appears to be cost effective. An hybrid « susceptible, infected, recovered (SIR) » compartmental transmission and Markov decision analytic model was used to simulate the cost-effectiveness of antiviral treatment based on a POCRT for influenza A in the social perspective. Data input parameters used were retrieved from peer-review published studies and government databases. The outcome considered was the incremental cost per life-year saved for one seasonal influenza season. In the base-case analysis, the antiviral treatment based on POCRT saves 2 lives/100,000 person-years and costs $7600 less than the empirical antiviral treatment based on clinical judgment alone, which demonstrates that the POCRT-based strategy is dominant. In one and two way-sensitivity analyses, results were sensitive to the POCRT accuracy and cost, to the vaccination coverage as well as to the prevalence of influenza A. In probabilistic sensitivity analyses, the POCRT strategy is cost-effective in 66% of cases, for a commonly accepted threshold of $50,000 per life-year saved. The influenza antiviral treatment based on POCRT could be cost-effective in specific conditions of performance, price and disease prevalence.

Scaling Up HIV Testing in an Academic Emergency Department: An Integrated Testing Model with Rapid Fourth-Generation and Point-of-Care Testing.

We evaluated two approaches for implementing routine HIV screening in an inner-city, academic emergency department (ED). These approaches differed by staffing model and type of HIV testing technology used. The programmatic outcomes assessed included the total number of tests performed, proportion of newly identified HIV-positive patients, and proportion of newly diagnosed individuals who were linked to care. This study examined specific outcomes for two distinct, successive approaches to implementing HIV screening in an inner-city, academic ED, from July 2012 through June 2013 (Program One), and from August 2013 through July 2014 (Program Two). Program One used a supplementary staff-only HIV testing model with point-of-care (POC) oral testing. Program Two used a triage-integrated, nurse-driven HIV testing model with fourth-generation blood and POC testing, and an expedited linkage-to-care process. During Program One, 6,832 eligible patients were tested for HIV with a rapid POC oral HIV test. Sixteen patients (0.2%) were newly diagnosed with HIV, of whom 13 were successfully linked to care. During Program Two, 8,233 eligible patients were tested for HIV, of whom 3,124 (38.0%) received a blood test and 5,109 (62.0%) received a rapid POC test. Of all patients tested in Program Two, 29 (0.4%) were newly diagnosed with HIV, four of whom had acute infections and 27 of whom were successfully linked to care. We found a statistically significant difference in the proportion of the eligible population tested-8,233 of 49,697 (16.6%) in Program Two and 6,832 of 46,818 (14.6%) in Program One. These differences from Program One to Program Two corresponded to increases in testing volume (n=1,401 tests), number of patients newly diagnosed with HIV (n=13), and proportion of patients successfully linked to care (from 81.0% to 93.0%). Integrating HIV screening into the standard triage workflow resulted in a higher proportion of ED patients being tested for HIV as compared with the supplementary staff-only HIV testing model. New rapid fourth-generation testing technology allowed the identification of acute HIV infection and same-visit confirmation of a positive diagnosis.