Ethical, Financial, and Legal Considerations to Implementing Emergency Department HIV Screening: A Report From the 2007 Conference of the National Emergency Department HIV Testing Consortium

Waxman, Michael; Popick, Rachel; Merchant, Roland C.; Rothman, Richard E.; Shahan, Judy B.; Almond, Gregory

doi:10.1016/j.annemergmed.2011.03.021

Cited by 14 publications

(19 citation statements)

References 34 publications

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“…54 In fact, lack of funding or reimbursement for HIV testing was listed as a major reason by community health care professionals for not performing HIV screening on their patients. 33,36,52 There was also a worry that the health care system in the United States would not be able to bear the burden and cost of caring for increased numbers of people being diagnosed as having HIV infection. 55 What these physicians may not fully appreciate is the substantially increased cost of care for patients diagnosed late in the course of their HIV disease and the increased societal costs of additional cases of HIV when people with undiagnosed infection spread HIV to their partners.…”

Section: Systemic Barriersmentioning

confidence: 97%

“…51 This dichotomy between prevention and care remains a significant hurdle for health care workers who do not have the infrastructure needed to follow up on HIV test results and ensure that all HIV-positive patients are referred for HIV care. 47,52 The current CDC recommendation for HIV screening in the health care setting does away with many of the facility-and physician-level systemic barriers, such as the need for counseling and separate written informed consent. However, it does not remove all the barriers, perceived or otherwise, associated with the mechanics of ordering tests, as well as interpreting and reporting test results, or informing patients of their test results.…”

Section: Systemic Barriersmentioning

confidence: 99%

“…The legal implications of HIV screening continue to make health care providers anxious. 33,36,52 Although national recommendations influence state law, HIV testing laws remain under state jurisdiction. Given that most health care professionals are not directly involved in providing HIV care, many would not be familiar with state laws pertaining to HIV testing.…”

Section: Systemic Barriersmentioning

confidence: 99%

“…There is also a general sense of insecurity regarding partner notification and the physician's legal roles and obligations. 52 Because HIV screening programs must comply with state laws about HIV testing, physicians should have a clear and easily accessible source of information about state laws relevant to their practice. The Compendium of State HIV Testing Laws from the National HIV/AIDS Clinicians' Consultation Center provides state profiles of key HIV testing laws and policies and is updated periodically.…”

Section: Systemic Barriersmentioning

confidence: 99%

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HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions

Rizza

MacGowan

Purcell

et al. 2012

Mayo Clinic Proceedings

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Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States.

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Section: Systemic Barriersmentioning

confidence: 97%

Section: Systemic Barriersmentioning

confidence: 99%

Section: Systemic Barriersmentioning

confidence: 99%

Section: Systemic Barriersmentioning

confidence: 99%

See 2 more Smart Citations

HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions

Rizza

MacGowan

Purcell

et al. 2012

Mayo Clinic Proceedings

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“…12 The Annals of Emergency Medicine created a special supplement dedicated to the topic of HIV screening in emergency department. 13 Numerous peer-reviewed publications have addressed emergency department-based HIV screening issues including ethical, financial, and legal considerations, 14 cost effectiveness, patient perceptions, 16,17 prevalence estimates, 18,19 and linkage to care. 20 Yet the impact of routine HIV screening on emergency department patients belonging to the MSM community has not been well documented.…”

mentioning

confidence: 99%

Diagnosing HIV in Men Who Have Sex with Men: An Emergency Department's Experience

Copeland

Shah

Wheatley

et al. 2012

AIDS Patient Care and STDs

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In the United States, men who have sex with men (MSM) constitute the risk group in which the prevalence of new HIV infection is increasing. The percentage of undiagnosed HIV infection and HIV risk behaviors in MSM and non-MSM participating in an emergency department-based rapid HIV screening program were compared. Medical records of all male patients participating in the program from May 2008 to October 2010 were reviewed. MSM were identified as male or male-to-female patients reporting oral and/or anal sex with a male. Males eligible for testing were aged 18 or older, English-speaking, not known to be HIV infected, and able to decline testing. A total of 6672 males were approached for testing; 5610 (84.1%) accepted, 366 (6.5%) were MSM, and 5244 (93.5%) were non-MSM. A total of 90.7% were black. Median age was 41. Fifty-nine MSM (16.1%) were diagnosed with HIV compared to 81 (1.5%) non-MSM. MSM were 10 times more likely than non-MSM to have undiagnosed HIV infection (odds ratio [OR] 10.4, 95% confidence interval [CI] 7.3, 14.0). HIV-infected MSM (median age, 26) were younger than non-MSM (median age, 41). HIV-infected non-MSM were 2 times more likely than MSM to have CD4 counts less than 200 cells per microliter. MSM were more likely to report previous HIV testing (OR 1.9, 95% CI 1.4, 2.5) and risk behaviors, including sex without a condom (OR 2.0, 95% CI 1.5, 2.6), sex with an HIV-infected partner (OR 14.6, 95% CI 8.3, 25.6) and sex with a known injection drug user (OR 4.1, 95% CI 2.0, 8.4). Further investigation of emergency department-based HIV testing and risk reduction programs targeting MSM is warranted.

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Clarifying the volume of estimated need for public health and prevention services within an emergency department population

et al. 2020

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Objectives Emergency departments (EDs) are called to implement public health and prevention initiatives, such as infectious disease screening. The perception that ED resources are insufficient is a primary barrier. Resource needs are generally conceptualized in terms of total number of ED encounters, without formal calculation of the number of encounters for which a service is required. We illustrate potential differences in the estimated volume of service need relative to ED census using the examples of HIV and hepatitis C (HCV) screening. Methods This cross‐sectional analysis adjusted the proportion of ED encounters in which patients are eligible for HIV and HCV screening according to a cascade of successively more restrictive patient selection criteria, presuming full implementation of each criterion. Parameter estimates for the proportion satisfying each selection criterion were derived from the electronic health records of an urban academic facility and its ED HIV and HCV screening program during 2 time periods. The primary outcome was the estimated reduction in proportion of ED visits eligible for screening after application of the entire cascade. Results There were 76,104 ED encounters during the study period. Applying all selection criteria reduced the number of required screens by 97.1% (95% confidence interval, 97.0–97.2) for HIV and 86.1% (95% confidence interval, 85.9–86.3) for HCV. Conclusions Using the example of HIV and HCV screening, the application of eligibility metrics reduces the volume of service need to a smaller, more feasible number than estimates from ED census alone. This approach might be useful for clarifying perceived service need and guiding operational planning.

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Ethical, Financial, and Legal Considerations to Implementing Emergency Department HIV Screening: A Report From the 2007 Conference of the National Emergency Department HIV Testing Consortium

Cited by 14 publications

References 34 publications

HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions

HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions

Diagnosing HIV in Men Who Have Sex with Men: An Emergency Department's Experience

Clarifying the volume of estimated need for public health and prevention services within an emergency department population

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