Emergency Provider Attitudes and Barriers to Universal HIV Testing in the Emergency Department

Abstract

Background-The Centers for Disease Control and Prevention (CDC) recently published recommendations for routine, voluntary human immunodeficiency virus (HIV) testing of adults in all healthcare settings, including the emergency department (ED).

Effect of testing experience and profession on provider acceptability of rapid HIV testing after implementation in public sexual health clinics in Sydney

“…Although there is limited international research in this area, this increase in acceptability over time is consistent with findings in three other studies [12,15,17]. However, one study in an emergency department did not find an increase in acceptability over time as a result of barriers to RHT in that setting persisting 6 months after initiation [30].The Determine HIV Combo assay used in our study was the first point-of-care test designed to increase sensitivity in acute HIV infection by detecting both HIV antibody and antigen. However, the sensitivity reported for the assay's antigen component in the laboratory [33][34][35] has not been shown in evaluations using finger-prick blood specimens at the point of care [31,36].…”

“…In contrast, RHT involves finger-prick blood or oral fluid specimen collection with results provided during the same visit, which may make testing more convenient. Barriers to implementing RHT reported among service providers include: lack of time [12,13]; lack of confidence in their own competency and skills and fear of delivering positive results [14,15]; concern regarding reliability and false positive results [16,17]; and perceiving RHT as too difficult for nonexperts [18].Although many studies have assessed acceptability of RHT in a variety of settings and patient groups, and among providers at various stages of implementation [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28], few studies have assessed differences in acceptability between professions [29,30]. To our knowledge, no published studies have examined if the number of tests performed and experience of false test results impact on provider acceptability.…”

Testing and Linkage to Care Outcomes for a Clinician-Initiated Rapid HIV Testing Program in an Urban Emergency Department

“…In addition, external funding was used to support the linkage to care team, as concern about patient follow-up has been a commonly cited barrier to clinician-initiated emergency department HIV testing. 15 The effort of the program coordinator and the linkage team corresponded to 2 full-time equivalent positions (FTEs). The program's cost effectiveness is reported separately.…”

Primary Care in the Emergency Department – An Untapped Resource for Public Health Research and Innovation

“…A survey of ED directors found that the main barriers to providing preventive health services in the ED are financial and time constraints (7). In addition, emergency physicians cite the perceived lack of follow-up as a reason not to provide active surveillance for chronic diseases (8). However, even with readily identifiable chronic disorders such as hypertension, emergency physicians are reticent to prescribe antihypertensive therapy and vastly overestimate their own referral practices for outpatient follow-up (9,10).…”