scholarly journals P145: HIV point of care testing by community paramedics in a vulnerable population: a pilot study

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S126-S126 ◽  
Author(s):  
H. Yaworski ◽  
P. Hutlet ◽  
R. Grierson ◽  
E. Weldon ◽  
R. Sneath ◽  
...  
Keyword(s):  
Inner City ◽  
Hiv Testing ◽  
Large Scale ◽  
Point Of Care ◽  
Future Research ◽  
Point Of Care Testing ◽  
Post Test ◽  
Study Population ◽  
The Mean ◽  
Age Range

Introduction: Literature suggests that up to 25% of people with HIV in North America are unaware of their status and are at risk to transmit the virus unknowingly. A high proportion of HIV patients are diagnosed when the disease is more advanced, with CD4 counts < 200. This study examined the rates of HIV testing, detection, and treatment of clients at an inner city shelter and detoxification centre after the introduction of a point of care testing (POCT) program by on-site community paramedics (CP). Methods: In 2013, in collaboration with a regional HIV program, CP received training and instituted an HIV POCT program and post-test counselling initiative. A retrospective electronic database review from October 16, 2013 to October 15, 2014 of adult patients who received testing was performed. Demographic and testing details of each patient encounter were abstracted and select variables were compared to a historic population who received POC HIV testing at an inner city emergency department (ED) in the same city. Results: 1,207 HIV POC tests were performed on 997 patients during the pilot. 57% of the patients tested were less than 40 years of age (range 18-73 years) compared to 55% in the historic ED population. A total of 9 reactive cases were identified in the study population including 3 new cases, 5 previously known cases, and 1 false reactive result. The mean age of the new cases was 47 years, vs 44 in the historical control. All 3 new cases were referred to a local HIV clinic for further care and treatment. New HIV cases represented 0.25% of total tests performed, which is less than the expected prevalence rate of 1% for this population, as well as the rate of 1.4% found in the ED population. Conclusion: Despite lower than expected reactive rates, the large scale implementation of a CP HIV POCT program in an inner city shelter and detoxification centre is feasible. All patients with new reactive tests were immediately connected to care. Future research will focus on risk factors and barriers to testing.

scholarly journals Addressing Barriers to HIV Point-of-Care Testing in Community Pharmacies

Pharmacy ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 84
Author(s):  
Kimberly McKeirnan ◽  
Sorosh Kherghehpoush ◽  
Angie Gladchuk ◽  
Shannon Patterson
Keyword(s):  
Hiv Testing ◽  
Point Of Care ◽  
Diagnostic Testing ◽  
Healthcare Providers ◽  
Training Session ◽  
Community Pharmacists ◽  
Hiv Screening ◽  
Hiv Education ◽  
Point Of Care Testing ◽  
Post Test

Significant numbers of human immunodeficiency virus (HIV) infections are transmitted unknowingly, making efforts to increase HIV testing accessibility crucial. As trusted healthcare providers, pharmacists can increase accessibility of HIV screening and referral services. However, challenges with lack of private counseling and testing space, need for training and education, lack of adequate staffing, heavy workload, and uncertainty supporting patients with reactive results have been previously reported by community pharmacists as barriers to offering HIV screening. The objective of this study was to investigate pharmacists’ opinions of strategies for addressing these barriers. A survey was developed to gather information regarding steps that could be taken to increase pharmacist comfort and interest offering HIV point-of-care testing (POCT) services. Thirty pharmacies were contacted and representatives from twenty-six responded. Pharmacists reported that they were likely or very likely to offer HIV POCT if they were given the following: a 2 h training session on administering and interpreting HIV POCT (73%); a 4 h education session on a variety of HIV education topics (73%); training about couples testing, post-test counseling, and de-escalation techniques (58%); or a semi-annual CE training (58%). Pharmacist respondents were likely or very likely (81%) to implement HIV POCT if there was a protocol in place so that patients with a reactive screening would out be referred for diagnostic testing and if there was a script provided as a template for post-test counseling (81%). The majority of pharmacists (69%) also preferred the appointment-based model rather than a walk-in or combination option and preferred (77%) having 20–30 min of dedicated time with the patient to provide adequate testing, education, and counseling. By using these strategies to improve comfort and likelihood implementing HIV POCT, pharmacists can increase access to HIV testing and decrease the spread of HIV.

Point-of-Care Testing Using Invasive and Non-Invasive Hemoglobinometers: Reliable and Valid Method for Estimation of Hemoglobin among Children 6–59 Months

2020 ◽  
Author(s):  
Gomathi Ramaswamy ◽  
Kashish Vohra ◽  
Kapil Yadav ◽  
Ravneet Kaur ◽  
Tripti Rai ◽  
...  
Keyword(s):  
Point Of Care ◽  
Venous Blood ◽  
Public Health Problem ◽  
Outpatient Department ◽  
Point Of Care Testing ◽  
Adequate Treatment ◽  
Non Invasive ◽  
Hematology Analyzer ◽  
The Mean ◽  
Study Participants

Abstract Introduction Globally around 47.4% of children and in India, 58% of children aged 6–59 months are anemic. Diagnosis of anemia in children using accurate technologies and providing adequate treatment is essential to reduce the burden of anemia. Point-of-care testing (POCT) devices is a potential option for estimation of hemoglobin in peripheral and field settings were the hematology analyzer and laboratory services are not available. Objectives To access the validity of the POCTs (invasive and non-invasive devices) for estimation of hemoglobin among children aged 6–59 months compared with hematology analyzer. Methods The study participants were enrolled from the pediatric outpatient department in Haryana, India, from November 2019 to January 2020. Hemoglobin levels of the study participants were estimated in Sahli’s hemoglobinometer and invasive digital hemoglobinometers (DHs) using capillary blood samples. Hemoglobin levels in non-invasive DH were assessed from the finger/toe of the children. Hemoglobin levels measured in POCTs were compared against the venous blood hemoglobin estimated in the hematology analyzer. Results A total of 120 children were enrolled. The mean (SD) of hemoglobin (g/dl) estimated in auto-analyzer was 9.4 (1.8), Sahli’s hemoglobinometer was 9.2 (1.9), invasive DH was 9.7 (1.9), and non-invasive DH was 11.9 (1.5). Sahli’s hemoglobinometer (95.5%) and invasive DH (92.2%) had high sensitivity for the diagnosis of anemia compared with non-invasive DH (24.4%). In contrast, non-invasive DH had higher specificity (96.7%) compared with invasive DH (83.3%) and Sahli’s hemoglobinometer (70%). Invasive DH took the least time (2–3 min) for estimation of hemoglobin per participant, followed by Sahli’s (4–5 min) and non-invasive DH (5–7 min). Conclusion All three POCT devices used in this study are reasonable and feasible for estimating hemoglobin in under-5 children. Invasive DHs are potential POCT devices for diagnosis of anemia among under-5 children, while Sahli’s can be considered as a possible option, where trained and skilled technicians are available. Further research and development are required in non-invasive DH to improve accuracy. Lay summary In India, anemia is a serious public health problem, where 58% of the children aged 6–59 months are anemic. Point-of-care testing (POCT) using digital hemoglobinometers (DHs) has been recommended as one of the key interventions by the Anemia Mukt Bharat program since 2018 in India. These POCT devices are easy to use, less invasive, can be carried to field, require minimal training and results are available immediately. Therefore this study assessed the validity of POCT devices—invasive DH, non-invasive DH and Sahli’s hemoglobinometer among 6–59 months children in facility setting compared with the gold standard hematology analyzer. A total of 120 children under 6–59 months of age were enrolled from the pediatric outpatient department in Haryana, India, from November 2019 to January 2020. The (mean hemoglobin in g/dl) invasive (9.7) and non-invasive DH (11.9) overestimated hemoglobin value, while Sahli’s (9.2) underestimated hemoglobin compared with hematology analyzer (9.4). Invasive DH (92.2%) and Sahli’s hemoglobinometer (95.5%) reported high ability to correctly identify those with anemia compared with non-invasive DH (24.4%). In contrast, non-invasive DH (96.73%) had higher ability to correctly identify those without the anemia compared with invasive DH (83.3%) and Sahli’s (70%).

scholarly journals Feasibility and Success of Hiv Point-of-Care Testing in an Emergency Department in an Urban Canadian Setting

2013 ◽  
Vol 24 (1) ◽  
pp. 27-31 ◽  
Author(s):  
Marissa L Becker ◽  
Laura H Thompson ◽  
Carla Pindera ◽  
Natalie Bridger ◽  
Carmen Lopez ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hiv Testing ◽  
Point Of Care ◽  
Venous Blood ◽  
Tertiary Care ◽  
Antibody Test ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Post Test ◽  
Centre Hospital

BACKGROUND: Approximately 26% of Canadians living with HIV are unaware of their status. Point-of-care (POC) HIV tests have been introduced to simplify and expand HIV testing.OBJECTIVE: To evaluate the feasibility and acceptability of POC testing in an emergency department (ED) setting in Winnipeg, Manitoba.METHODS: A cross-sectional study of unselected adults presenting to the ED at the Health Sciences Centre Hospital (Winnipeg, Manitoba) was performed. Study procedures included pre- and post-test counselling, administration of the INSTI HIV-1/HIV-2 Antibody Test (bioLytical Laboratories, Canada) and a brief questionnaire. Venous blood samples were collected from participants for confirmatory testing on all reactive and indeterminate specimens.RESULTS: In total, 501 adults participated in the study. The majority of participants were younger than 40 years of age, approximately one-half (48.5%) were women and 53% self-identified as Aboriginal. Nearly one-half (49.1%) of the participants had undergone previous HIV testing, although 63% of these tests were performed more than a year earlier. A total of seven individuals tested reactive with the POC test, all of whom were confirmed positive using serological testing (1.4%) and were linked to an HIV specialist within 24 h. Nearly all of the participants (96%) reported satisfaction with the test and believed it belonged in the ED (93%).CONCLUSIONS: Of the participants tested, 1.4% tested reactive for HIV, which is significantly higher than the reported prevalence in Manitoba and in other similar studies conducted in North America. Furthermore, all individuals were linked to timely care. The present study demonstrated that this particular busy tertiary care ED is an important and feasible location for HIV POC testing.

scholarly journals Economic analysis of the implementation of autologous transfusion technologies throughout England

2005 ◽  
Vol 21 (2) ◽  
pp. 234-239 ◽  
Author(s):  
Simon Dixon ◽  
Virge James ◽  
Daniel Hind ◽  
Craig J. Currie
Keyword(s):  
Policy Development ◽  
Large Scale ◽  
Future Research ◽  
Cell Salvage ◽  
Autologous Transfusion ◽  
The United Kingdom ◽  
Intraoperative Cell Salvage ◽  
The Mean ◽  
The Cost ◽  
Preoperative Autologous Donation

Objectives:This study aims to provide the first estimates of the costs and effects of the large scale introduction of autologous transfusion technologies into the United Kingdom National Health Service.Methods:A model was constructed to allow disparate data sources to be combined to produce estimates of the scale, costs, and effects of introducing four interventions. The interventions considered were preparing patients for surgery (PPS) clinics, preoperative autologous donation (PAD), intraoperative cell salvage (ICS), and postoperative cell salvage (PoCS).Results:The key determinants of cost per operation are the anticipated level of reductions in blood use, the mean level of blood use, mean length of stay, and the cost of the technology. The results show the potential for considerable reductions in blood use. The greatest reductions are anticipated to be through the use of PPS and ICS. Vascular surgery, transplant surgery, and cardiothoracic surgery appear to be the specialties that will benefit most from the technologies.Conclusions:Several simplifications were used in the production of these estimates; consequently, caution should be used in their interpretation and use. Despite the drawbacks in the methods used in the study, the model shows the scale of the issue, the importance of gathering better data, and the form that data must take. Such preliminary modeling exercises are essential for rational policy development and to direct future research and discussion among stakeholders.

scholarly journals Prevalence of HIV infection and acceptability of point-of-care testing in a Canadian inner-city emergency department

2016 ◽  
Vol 107 (3) ◽  
pp. e291-e295 ◽  
Author(s):  
Rob Stenstrom ◽  
Daphne Ling ◽  
Eric Grafstein ◽  
Rolando Barrios ◽  
Chris Sherlock ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hiv Infection ◽  
Inner City ◽  
Point Of Care ◽  
Point Of Care Testing

scholarly journals Tools to predict acute traumatic coagulopathy in the pre-hospital setting: a review of the literature

2020 ◽  
Vol 5 (3) ◽  
pp. 23-30
Author(s):  
Simon Robinson ◽  
Jordan Kirton
Keyword(s):  
Major Trauma ◽  
Point Of Care ◽  
Damage Control ◽  
Hospital Setting ◽  
Future Research ◽  
Blood Products ◽  
Point Of Care Testing ◽  
Acute Traumatic Coagulopathy ◽  
Prediction Tools ◽  
Traumatic Coagulopathy

<sec id="s1">Introduction: Recognising acute traumatic coagulopathy (ATC) poses a significant challenge to improving survival in emergency care. Paramedics are in a prime position to identify ATC in pre-hospital major trauma and initiate appropriate coagulopathy management. </sec> <sec id="s2">Method: A database literature review was conducted using Scopus, CINAHL and MEDLINE. </sec> <sec id="s3">Results: Two themes were identified from four studies: prediction tools, and point-of-care testing. Prediction tools identified key common ATC markers in the pre-hospital setting, including: systolic blood pressure, reduced Glasgow Coma Score and trauma to the chest, abdomen and pelvis. Point-of-care testing was found to have limited value. </sec> <sec id="s4">Conclusion: Future research needs to explore paramedics using prediction tools in identifying ATC, which could alert hospitals to prepare for blood products for damage control resuscitation. </sec>

scholarly journals Apolipoprotein A-I and B levels in Bangladeshi patients with coronary artery disease

2016 ◽  
Vol 9 (1) ◽  
pp. 31-33
Author(s):  
Ashesh K Chowdhury ◽  
Abu Mohammed Shafique ◽  
Zeenat F Rahman
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Large Scale ◽  
Control Group ◽  
Total Study Population ◽  
Apo B ◽  
Apolipoprotein A ◽  
Study Population ◽  
The Mean ◽  
Artery Disease

Coronary arteay disease (CAD) is an important cause of morbidity and mortality in developed as well as developing countries like Bangladesh. In this study, the status of serum apolipoprotein A-I (Apo A-1) and apolipoprotein B (Apo B) levels were assessed in Bangladeshi patients with coronary artery diseases. The study was carried out in the Department of Cardiology, University Cardiac Centre (UCC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Total study population was 100, of which 50 were patients with CAD and 50 were individuals without CAD (control). The patients with CAD and controls were enrolled following the inclusion and exclusion criteria. About 5 ml blood was collected by venepuncture from each individual and apolipoprotein A-1 and B were determined by automated nephelometry. The mean age of total study population was 51.4 ± 10.8 years while the mean age of the patients and control was 51.3 ± 10.9 and 51.4 ± 10.9 years respectively. The Apo A-I level was significantly (p<0.01) different in CAD patients compared to control group (95.10 ± 20.50 mg/dl vs 113.47 ± 20.96 mg/dl). The ratio of Apo B and Apo A1 was also significantly higher (p<0.01) in CAD patients than that of controls (1.25 ± 0.40 vs 0.95 ± 0.26 while Apo B levels was not different among the two groups. The study revealed significant alteration of serum Apo A-I level and Apo B/Apo A-I ratio in patients with CAD compared to those without CAD. Further large-scale study is needed to evaluate the exact influence of apolipoproteins on coronary artery disease in Bengali ethnic population.Ibrahim Med. Coll. J. 2015; 9(1): 31-33

scholarly journals Can point-of-care testing shorten hospitalization length of stay? An exploratory investigation of infectious agents using regression modelling

2018 ◽  
Vol 25 (4) ◽  
pp. 1606-1617
Author(s):  
Eliona Gkika ◽  
Anna Psaroulaki ◽  
Yannis Tselentis ◽  
Emmanouil Angelakis ◽  
Vassilis S Kouikoglou
Keyword(s):  
Length Of Stay ◽  
Infectious Diseases ◽  
Hospital Stay ◽  
Point Of Care ◽  
Length Of Hospital Stay ◽  
Laboratory Diagnosis ◽  
Final Diagnosis ◽  
Point Of Care Testing ◽  
The Mean ◽  
The Impact

This retrospective study investigates the potential benefits from the introduction of point-of-care tests for rapid diagnosis of infectious diseases. We analysed a sample of 441 hospitalized patients who had received a final diagnosis related to 18 pathogenic agents. These pathogens were mostly detected by standard tests but were also detectable by point-of-care testing. The length of hospital stay was partitioned into pre- and post-laboratory diagnosis stages. Regression analysis and elementary queueing theory were applied to estimate the impact of quick diagnosis on the mean length of stay and the utilization of healthcare resources. The analysis suggests that eliminating the pre-diagnosis times through point-of-care testing could shorten the mean length of hospital stay for infectious diseases by up to 34 per cent and result in an equal reduction in bed occupancy and other resources. Regression and other more sophisticated models can aid the financing decision-making of pilot point-of-care laboratories in healthcare systems.

Pharmacist Testers in Multidisciplinary Health care Team Expand HIV Point-of-Care Testing Program

2013 ◽  
Vol 27 (6) ◽  
pp. 578-581 ◽  
Author(s):  
Elizabeth M. Sherman ◽  
Shara Elrod ◽  
Deberenia Allen ◽  
Paula Eckardt
Keyword(s):  
Health Care ◽  
Hiv Testing ◽  
Health Care Providers ◽  
Point Of Care ◽  
Health Care Team ◽  
Care Providers ◽  
Point Of Care Testing ◽  
Testing Program ◽  
Public Health Challenges ◽  
Hiv Serostatus

Knowledge of HIV serostatus is the first step to accessing treatment, reducing transmission, and mitigating public health challenges. We describe the expansion of an HIV point-of-care testing (POCT) program within a health care system utilizing pharmacists as testers. The testing program’s expansion is detailed and its impact assessed. The POCT program was evaluated by comparing the number of traditional HIV venipuncture tests to the number of POCTs performed across the health system as well as comparing the number of POCTs performed by clinical pharmacists to the number of tests at other POCT locations. Although pharmacists’ contributions to HIV prevention are well documented, pharmacists’ involvement in HIV testing initiatives is still nascent. Our POCT program demonstrates an effective HIV testing initiative driven by pharmacists and other health care providers.

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