Background: Human immunodeficiency virus (HIV) infection continues to expand worldwide, and a significant proportion of infection is still undiagnosed. Recent studies have addressed the impact and feasibility of ‘opt-out’ HIV screening in Emergency Departments (EDs) in urban settings at high HIV prevalence, whereas little is known about the yield of implementing ‘targeted’ HIV testing, especially in low-prevalence areas.

Objective: The present study undertakes a scoping review of research carried out on the implementation of targeted HIV screening of adult in EDs to determine the impact, feasibility and acceptability of HIV testing in different HIV prevalence settings.

Design: Online databases (EMBASE, MEDLINE) were used to identify papers published between 2000 to 2020. A three-concept search was employed with HIV (HIV, Human immunodeficiency virus infection, HIV infections), targeted testing (Target, screening or testing) and emergency medicine (Emergency Service, emergency ward, A&E, accident and emergency or Emergency Department) (28^th February 2020). Only full-text articles written in English, French, Spanish or Italian and using impact and/or feasibility and/or acceptability of the program as primary or secondary outcomes were analysed.

Results: The search provided 416 articles. Of these, 12 met inclusion criteria and were included in the final review. Most of the included studies were carried out in the United States (n=8; 67%) and in areas of high HIV prevalence (n=11; 92%). Three (20%) were randomized control studies. While the rate of newly diagnosed HIV cases varied widely (0.03-2.2%), likely due to methodological heterogeneity between studies, the linkage of new HIV diagnosis was often high (80-100%) and median CD4+ cell count was always greater than 200 cells per microliter. Targeted HIV screening was found to be cost-effective (out of 2 studies) and well accepted by participants (out 2 studies).

Conclusions: Targeted HIV screening at the ED can be impactful, feasible and well accepted, but often requires extra funding and staff. Most previous work has focused on areas of high disease prevalence.

背景：人类免疫缺陷病毒 (HIV) 感染在全球范围内持续扩大，很大一部分感染仍未确诊。最近的研究已经解决了在 HIV 流行率高的城市环境中急诊科 (ED) 中“选择退出”HIV 筛查的影响和可行性，而对实施“有针对性的”HIV 检测的效果知之甚少，尤其是在低流行率地区领域。

目标：本研究对在急诊室对成人进行有针对性的 HIV 筛查的研究进行范围审查，以确定 HIV 检测在不同 HIV 流行环境中的影响、可行性和可接受性。

设计：在线数据库（EMBASE、MEDLINE）用于识别2000年至2020年间发表的论文。采用三概念搜索HIV（HIV、人类免疫缺陷病毒感染、HIV感染）、靶向检测（Target、筛选或检测）和急诊医学（急诊服务、急诊病房、A&E、事故和急诊或急诊科）（2020 年 2 月28^日）。仅分析了以英语、法语、西班牙语或意大利语撰写并使用影响和/或可行性和/或计划的可接受性作为主要或次要结果的全文文章。

结果：搜索提供了 416 篇文章。其中，12 项符合纳入标准并被纳入最终审查。大多数纳入的研究是在美国（n =8；67%）和 HIV 高流行地区（n =11；92%）进行的。三项 (20%) 是随机对照研究。虽然新诊断的 HIV 病例率差异很大 (0.03-2.2%)，这可能是由于研究之间的方法异质性，但新的 HIV 诊断的联系通常很高 (80-100%) 并且 CD4+ 细胞计数中位数始终大于 200每微升细胞。发现有针对性的 HIV 筛查具有成本效益（在 2 项研究中）并且被参与者广泛接受（在 2 项研究中）。

结论：在急诊室进行有针对性的 HIV 筛查是有影响力的、可行的并且广为接受，但通常需要额外的资金和人员。以前的大部分工作都集中在疾病流行率高的地区。