Evaluación de un cuestionario de exposición de riesgo y condiciones clínicas para ayudar a seleccionar a los pacientes que deben ser cribados de infección por VIHresultados de la práctica clínica y comparación con otras herramientas

Laburpena

Objectives. Main objective: To assess a direct screening strategy in Primary Care using the RE&CI HIV questionnaire followed by a rapid HIV test in individuals with a positive RE&IC response. Secondary objective: To compare the sen and NPV in the ER&IC HIV questionnaire with those of the already validated DENVER and HIDES risk scales, and to study the economic repercussion in the use of these scales in comparison with the use of a universal diagnosis. Results. It was estimated that between 17th November 2013 and 17th January 2014 the total population (TP) attended in the Health Centre was 1,866 patients and of these 27% (501) were screened in the DRIVE02 study. The RE&IC questionnaire was positive in a 55% of the participants and they all underwent the rapid test (RTHIV). Of the 225 participants with RE&IC negative questionnaire, 16% demanded the rapid test even though they had been informed about their virtually zero risk of infection. Their main reasons for this was to assure themselves that they were not HIV infected. Only one patient of the 501 who completed the RE&IC questionnaire had a positive test, which is a NDHIV rate of 1.99% (CI 95%, 0.4 ‰, 11. 2‰) and of 2.8% (CI 0,5‰-15,8‰) if we only considered the 355 participants who underwent the test. None of the 80 participants with a negative questionnaire who asked for the rapid test were HIV positive. This confirms the previous results of the DRIVE01 study. The global saving of the program was 4,808€ (14,965€ screening 100%, 8,157€ screening 55% in positive RE&IC). The cost for each new HIV diagnosis with programed screening (55%) was 2,423 € in comparison with 4,047 € if undertaken in 100%. The saving was 1,624€, if the laboratory tests avoided were considered and this could have been higher if stricter criteria had been applied. The predictive capacity of the 3 tools for forecasting HIV infection in a low prevalence population (N:5,329) was compared. The population proportion with a positive RE&IC questionnaire was at of 51.2%, at the DENVER scale with a score>30 of 39.7% and in the HIDES 26.7% had at least one of the 15 clinical indicators for HIV infection. Sensitivity was 100% for the questionnaire, 72.7% for the DENVER scale and 91% for the IC HIDES list. The specificity of the 3 tools was 49%, 60.41% and 74.4% respectively. VPP was 0.8%, 0.76% and 1.4%. VPN was 100%, 99.8% and 99.9% respectively. The number of tests avoided with each tool was 2,601, 3,212 and 3,948 respectively. The cost for each new HIV diagnosis was 552€ with HIDES, 992€ for RE&IC and 1,058€ for DENVER. The effective incremental ratio cost with respect to the most economical strategy, the clinical indicator conditions of HIDES, was 440€ for RE&IC and 506€ for DENVER scale. Conclusions. - A low screening rate of HIV testing was observed in clinical practice. - The use of a specific validated self questionnaire together with fast HIV detection tests is useful screening strategy for a population with a low rate of prior screening. - The use of this screening method has identified a prevalence of undetected HIV infection in two cases per thousand individuals. - Annual Health Centre visits of people with undetected HIV were found to be more frecuent than other populations. - The RE&IC test had a 100% negative predictive value confirming the results of previous studies. - HIV testigs is widely accepted among the population. One third of the participants without HIV risk, according to the RE&IC questionnaire, asked to undertake the test. - The cost of this type of HIV screening is lower than that of routine HIV screening. - The estimated cost of the overall program and that of the newly diagnosed cases, was lower with HIDES, followed by the RE&IC, which was slightly higher. The DENVER scale had the highest costs. However, the lower cost differences between the two first tools does not justify the potential loss of new diagnosis of HIV infection. - The three screening tools analyzed avoided undertaking HIV testing, but only the RE&IC questionnaire detected all the infected subjects detected by routine strategy. - At the present time the most useful tool proposed is the RE&IC questionnaire which is the best screening strategy for HIV detection in a Primary Care Health Centre.