初诊治疗中快速检测HIV的推广(艾滋病协会康复分会试验之二): 一个群组随机对照试验,Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised群组随机的 controlled trial,RHIVA 2： the RHIVA 2 trial （ findings from the RHIVA 2 trial）,primary care (由医护人员提供的)最初保健护理(其后病人可转到专科就诊);初诊治疗;初级治疗;初级医疗保健.,Published Online: 28 April 2015,Background Many people with HIV are undiagnosed. Early diagnosis saves lives and reduces onward transmission. We assessed whether an education programme promoting rapid HIV testing in general practice would lead to increased and earlier HIV diagnosis.,许多HIV(艾滋病病毒)携带者未被诊断出来。
早期诊断可以挽救生命并减少传染进一步扩散我们评估在全科诊疗中推广 HIV快速检测的教育计划是否能促使HIV诊断率的提高及早期诊断Summary,摘要,我们在全科诊疗中推广 HIV快速检测，并评估该教育计划是否能促使HIV诊断率的提高及早期诊断拆句法）,Methods In this cluster randomised controlled trial in Hackney (London, UK), general practices were randomly assigned (1:1) to offer either opt-out rapid HIV testing to newly registering adults or continue usual care. All practices were invited to take part. Practices were randomised by an independent clinical trials unit statistician with a minimisation program最小化程序, maintaining allocation concealment隐秘性.,在哈克尼（英国伦敦）进行的群组随机对照试验中，全科医生被随机分配（1：1），一组对新注册的成年病人进行opt-out HIV快速检测 / 常规HIV快速检测 ；另一组则继续常规护理。
所有全科医生都受邀参加，并由一个独立的临床试验单位的统计员进行最小化随机分配，以确保分配的隐秘性〔1〕,注解：1 . 该测试采取“知情不拒绝(opt．out)”原则即将检测作为一种常规服务，如果就诊者不提出拒绝，就进行HIV检测Neither patients nor investigators were masked遮盖，掩饰 to treatment allocation. The primary outcome was CD4 count at diagnosis. Secondary outcomes were rate of diagnosis, proportion with CD4 count less than 350 cells per μL, and proportion with CD4 count less than 200 cells per μL微升. This study is registered withClinicalTrials.gov, number ISRCTN63473710.,患者和研究人员均未设盲治疗分配该研究注册于ClinicalTrials.gov, 注册号： ISRCTN63473710。
主要终点为诊断时CD4细胞计数；次要终点为诊断率, CD4细胞计数比例低于350个/μL.，及CD4细胞计数比例低于200个/μL Patients and investigators were masked to the assigned treatments. 患者和研究人员设盲治疗分配Findings 40 of 45 (89%) general practices agreed to participate: 20 were assigned to the intervention group (44 971 newly registered adult patients) and 20 to the control group (38 464 newly registered adult patients), between April 19, 2010, and Aug 31, 2012. Intervention practices diagnosed 32 people with HIV versus 14 in control practices.,干预组和对照组医生确诊的HIV感染者分别为32人与14人。
（转译法---句型转译）,45个全科医生中有40人（89％）同意参加：20个被分配到干预组（44971新注册成人患者），20个被分配到对照组（38464新注册成人患者），时间从2010年4月19日到2012年8月31日Mean CD4 count at diagnosis was 356 cells per μL (SD 254)in intervention practices versus 270 (SD 257) in control practices (adjusted difference of square root平方根差 CD4 count 3·1, 95% CI −1·2 to 7·4; p=0·16); in a pre-planned预设 sensitivity敏感性 analysis excluding patients diagnosed via antenatal产前的 care, the difference was 6·4 (95% CI, 1·2 to 11·6; p=0·017).,干预组诊断时CD4细胞平均计数为356个/μL（SD 254），对照组为270个/μL（SD 257）（CD4计数调整平方根差3.1，95％Cl -1.2-7.4,;P =0.16）;,在排除产前检查确诊患者的预设敏感性分析中，其差为6.4（95％Cl，1.2-11.6，P=0.017）。
Rate of HIV diagnosis was 0·30 (95% CI 0·11 to 0·85) per 10000 patients per year in intervention practices versus 0·07 (0·02 to 0·20) in control practices (adjusted ratio of geometric means几何平均数 4·51, 95% CI 1·27 to 16·05; p=0·021). 55% of patients in intervention practices versus 73% in control practices had CD4 count less than 350 cells per μL (risk ratio 0·75, 95% CI 0·53 to 1·07).,干预组每年每10000名患者的HIV诊断率为0.30（95％Cl 0.11至0.85）,对照组为0.07（0.02至0.20）（几何平均数调整率为4.51，95％Cl 1.27〜16.05，P=0.021）CD4细胞计数低于350个/ μL的患者在干预组中和对照组中分别为55％及73％（风险率为0·75，95％Cl 0.53〜1.07）。
（句型转译）,Funding UK Department of Health, NHS City and Hackney,英国卫生部 国民卫生服务体系 受托基金机构City & Hackney （增译法）,National Health Service trusts include NHS City & Hackney, NHS South West Essex, NHS Wigan, NHS Oxfordshire. http://en.wikipedia.org/wiki/Event_Marketing_Solutions,HIV: human immunodeficiency virusAIDS: Acquired immunodeficiency syndrome,opt-out rapid HIV testing：.尽管新检测咨询策略仍强调知情同意和自愿检测，但采取“知情不拒绝(opt．out)”即将检测作为一种常规服务，如果就诊者不提出拒绝，就进行HIV检测；不再提供检测前咨询服务，而是提供HIV检测前信息服务(pre—test information)，其差别在于没有个人危险因素评估和行为改变的内容。