HIV, trauma and the emergency departments: The CDC opt-out approach should be adopted in South Africa

Hardcastle, Timothy Craig; Hansoti, Bhakti

doi:10.7196/sajbl.2016.v9i2.486

Cited by 7 publications

(13 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the last decade, the medical literature has been unclear if the high mortality observed in patients with HIV infection or AIDS derives from the inability of this susceptible population to tolerate emergent surgical interventions or whether the natural course of the disease leads to higher mortality rates. For this reason, knowing the HIV status of emergency surgery patients is essential, and testing should be rapidly available [ 122 ]. The initial data on mortality and morbidity of HIV/AIDS patients undergoing surgical intervention was obtained mixing HIV-infected and AIDS patients, leading to a misperception and wrong approaches to surgical intervention in HIV patients.…”

Section: Patients With Hiv/aidsmentioning

confidence: 99%

Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines

et al. 2021

View full text Add to dashboard Cite

Immunocompromised patients are a heterogeneous and diffuse category frequently presenting to the emergency department with acute surgical diseases. Diagnosis and treatment in immunocompromised patients are often complex and must be multidisciplinary. Misdiagnosis of an acute surgical disease may be followed by increased morbidity and mortality. Delayed diagnosis and treatment of surgical disease occur; these patients may seek medical assistance late because their symptoms are often ambiguous. Also, they develop unique surgical problems that do not affect the general population. Management of this population must be multidisciplinary.This paper presents the World Society of Emergency Surgery (WSES), Surgical Infection Society Europe (SIS-E), World Surgical Infection Society (WSIS), American Association for the Surgery of Trauma (AAST), and Global Alliance for Infection in Surgery (GAIS) joined guidelines about the management of acute abdomen in immunocompromised patients.

show abstract

Section: Patients With Hiv/aidsmentioning

confidence: 99%

Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines

et al. 2021

View full text Add to dashboard Cite

show abstract

“…[ 19 – 22 ] In 2006, the United States Centers for Disease Control and Prevention (CDC) explicitly recognized the critical roles of EDs in the national HIV strategy after programs reported high rates of detection and linkage to care from this venue. [ 19 , 23 – 25 ] Several studies in Low and Middle-Income Countries (LMICs) have also demonstrated high HIV prevalence in the ED population (23% in Kenya, 26% in Malawi and 43% in Uganda). [ 26 – 28 ] HIV testing in South African EDs may provide an opportunity to capture patients who are currently missed by existing testing programs.…”

Section: Introductionmentioning

confidence: 99%

HIV testing in a South African Emergency Department: A missed opportunity

et al. 2018

Self Cite

View full text Add to dashboard Cite

BackgroundSouth Africa has the largest HIV epidemic in the world, with 19% of the global number of people living with HIV, 15% of new infections and 11% of AIDS-related deaths. Even though HIV testing is mandated in all hospital-based facilities in South Africa (SA), it is rarely implemented in the Emergency Department (ED). The ED provides episodic care to large volumes of undifferentiated who present with unplanned injury or illness. Thus, the ED may provide an opportunity to capture patients with undiagnosed HIV infection missed by clinic-based screening programs.Methods and findingsIn this prospective exploratory study, we implemented the National South African HIV testing guidelines (counselor initiated non-targeted universal screening with rapid point of care testing) for 24-hours a day at Frere Hospital in the Eastern Cape from September 1st to November 30th, 2016. The purpose of our study was to quantify the burden of undiagnosed HIV infection in a South African ED setting. Furthermore, we sought to evaluate the effectiveness of the nationally recommended HIV testing strategy in the ED. All patients who presented for care in the ED during the study period, and who were clinically stable and fully conscious, were eligible to be approached by HIV counseling and testing (HCT) staff to receive a rapid point-of-care HIV test. A total of 2355 of the 9583 (24.6%) patients who presented to the ED for care during the study period were approached by the HCT staff, of whom 1714 (72.8%) accepted HIV testing. There was a high uptake of HIV testing (78.6%) among a predominantly male (58%) patient group who mostly presented with traumatic injuries (70.8%). Four hundred (21.6%) patients were HIV positive, including 115 (6.2%) with newly diagnosed HIV infection. The overall prevalence of HIV infection was twice as high in females (29.8%) compared to males (15.4%). Both sexes had a similar prevalence of newly diagnosed HIV infection (6.0% for all females and 6.4% for all males) in the ED.ConclusionsOverall there was high HIV testing acceptance by ED patients. A non-targeted testing approached revealed a high HIV prevalence with a significant burden of undiagnosed HIV infection in the ED. Unfortunately, a counselor-driven HIV testing approach fell short of meeting the testing needs in this setting, with over 75% of ED patients not approached by HCT staff.

show abstract

“…Translation of national HIV testing guidelines to practice in the ED has been challenging worldwide [ 24 – 27 ]. Significant resistance to embedding HCT as routine practice in EDs has been raised by some in the emergency medicine community who are reluctant to re-negotiate existing practices in an already complex clinical setting [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Changing HCW attitudes: a case study of normalizing HIV service delivery in emergency departments

Rao

Chen

Hill

et al. 2022

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

Background Delays in the implementation of evidence-based practices are significant and ubiquitous, compromising health outcomes. Resistance to change is a key factor in hindering adoption and integration of new evidence-based interventions. This study seeks to understand the impact of exposure to HIV testing within a research context on provider attitudes towards HIV counselling and testing (HCT) in emergency departments (ED). Methods This is a pre-and-post study design measuring the effect of a new ED-based HCT intervention, conducted by lay counsellors, on provider attitudes in Eastern Cape, South Africa. A validated, anonymized, 7-item survey was self-completed by routine care providers (physicians, nurses, and case managers). Questions were scored on a 5-point Likert scale with 5 consistently reflecting a positive attitude. Mean scores were calculated for each question and compared using a two-sample t-test to assess change in sample means for attitudes among providers surveyed before and after the intervention. Results A total of 132 surveys were completed across three EDs. Majority of respondents were female (70.5%), 20–29 years old (37.9%), of African race (81.1%), nurses (39.4%), and practicing medicine for 0–4 years (37.9%). Pre-intervention, providers displayed a positive attitude towards ‘the benefit of offering ED-based HCT to patients’ (4.33), ‘the ED offering HCT’ (3.53), ‘all ED patients receiving HCT’ (3.42), ‘concern about patient reaction to HCT’ (3.26), and ‘comfort with disclosing HCT results’ (3.21); and a mildly negative attitude towards ‘only high-risk ED patients receiving HCT’ (2.68), and ‘the burden of offering HCT in a clinical environment’ (2.80). Post-intervention, provider attitudes improved significantly towards ‘all ED patients receiving HCT’ (3.86, p < 0.05), ‘only high-risk ED patients receiving HCT’ (2.30, p < 0.05), ‘the burden of offering HCT in a clinical environment’ (3.21, p < 0.05), and ‘comfort with disclosing HCT results’ (3.81, p < 0.05). Conclusions Controlled exposure to new practices with a structured implementation period can shift attitudes beginning a process of practice normalization. In our study, we observed improvements in provider attitudes regarding the benefits of HCT and the burden of offering HCT to all patients in the ED. Research activities may have a role in mitigating resistance to change and supporting intervention adoption.

show abstract

HIV, trauma and the emergency departments: The CDC opt-out approach should be adopted in South Africa

Cited by 7 publications

References 30 publications

Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines

Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines

HIV testing in a South African Emergency Department: A missed opportunity

Changing HCW attitudes: a case study of normalizing HIV service delivery in emergency departments

Contact Info

Product

Resources

About