The role of nurses in HIV screening in health care facilities: A systematic review

Leblanc, Judith; Burnet, Espérie; d’Almeida, Kayigan Wilson; Simon, Tabassome; Crémieux, Anne‐Claude

doi:10.1016/j.ijnurstu.2015.04.007

Cited by 14 publications

(13 citation statements)

References 51 publications

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“…Although a targeted strategy reduces the number of tests performed and the inherent workload, compared to nontargeted screening, questionnaire distribution gradually decreased with increasing patient volume. This has been well documented in nontargeted screening (d'Almeida et al, ; Elgalib et al, ; Leblanc et al, ). Another barrier was the downward trend of questionnaire distribution rates over time, a factor also observed with the nontargeted strategy (Casalino et al, ).…”

Section: Discussionmentioning

confidence: 64%

“…Facilitating factors and barriers have been explored for the nontargeted screening approach at patient and ED levels (d'Almeida et al, ; Deblonde et al, ; Elgalib et al, ; Leblanc et al, ; Schnall & Liu, ). Barriers such as time constraints, lack of knowledge, concerns about patient follow‐up, and costs were primarily operational in nature.…”

Section: Discussionmentioning

confidence: 99%

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Implementation of Nurse‐Driven HIV Screening Targeting Key Populations in Emergency Departments: A Multilevel Analysis From the DICI‐VIH Trial

Leblanc

Côté

Pagé

et al. 2019

Worldviews Ev Based Nurs

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Background: In countries with concentrated HIV epidemics, optimizing screening to reach individuals with undiagnosed infection is essential. The DICI-VIH study, a cluster-randomized crossover trial conducted in eight French emergency departments (EDs), found that a strategy combining nurse-driven targeted HIV screening with routine diagnostic testing was effective.Aim: The aim was to investigate factors associated with the implementation of HIV screening targeting key populations in EDs.Methods: A self-administered questionnaire was distributed at registration to patients aged 18-64 years and able to give consent during the DICI-VIH intervention. Based on their responses, those belonging to key populations were offered a rapid test by triage nurses. Two key stages of the process were evaluated: questionnaire distribution by providers and test acceptance by patients. Patient information, daily workload, and ED characteristics were collected. The associations between these variables and (a) the proportion of questionnaires distributed and (b) the proportion of tests accepted were evaluated using multilevel modeling in order to examine differences in screening implementation between EDs.Results: Questionnaire distribution proportions varied from 23% to 48% across EDs. They were higher on weekdays than weekends (odds ratio, OR: 3.77; 95% CI: 3.57-3.99) and when research staff participated (OR: 1.31; 95% CI: 1.26-1.37). They decreased over time (OR: 0.76; 95% CI: 0.71-0.82; 4th [Q3] vs. 1st quartile [Q0] of intervention days) and with increased patient flow (OR: 0.61; 95% CI: 0.56-0.67; Q3 vs. Q0 of eligible patients). Test acceptance varied from 64% to 77% across EDs, increased with research staff participation (OR 1.20; 95% CI: 1.03-1.40), and decreased over time (OR: 0.75; 95% CI: 0.60-0.92; Q3 vs. Q0). Patients who accepted were more likely to be younger (OR: 0.76; 95% CI: 0.61-0.96; 50-64-year-old vs. 30-39-year-old patients).Linking Evidence to Action: Patient flow, intervention duration, weekdays, and research staff participation were important determinants of targeted screening implementation. These findings could help guide future implementation in similar settings.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Implementation of Nurse‐Driven HIV Screening Targeting Key Populations in Emergency Departments: A Multilevel Analysis From the DICI‐VIH Trial

Leblanc

Côté

Pagé

et al. 2019

Worldviews Ev Based Nurs

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“…Studies evaluating nurse-driven HIV screening, compared to screening performed by other health care staff, showed a trend in higher test offering, better acceptance and higher delivery rates with the implementation of nurse-driven HIV screening [ 24 ]. However, a progressive decrease in test offering rates from nurses and other staff over time has been observed, most likely resulting from of a loss of motivation related to the small number of new diagnoses, which were concentrated in patients at high risk of HIV exposure [ 20 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of nurse-driven targeted HIV screening in 8 emergency departments: study protocol for the DICI-VIH cluster-randomized two-period crossover trial

Leblanc

Rousseau²,

Hejblum

et al. 2015

BMC Infect Dis

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BackgroundIn 2010, to reduce late HIV diagnosis, the French national health agency endorsed non-targeted HIV screening in health care settings. Despite these recommendations, non-targeted screening has not been implemented and only physician-directed diagnostic testing is currently performed. A survey conducted in 2010 in 29 French Emergency Departments (EDs) showed that non-targeted nurse-driven screening was feasible though only a few new HIV diagnoses were identified, predominantly among high-risk groups. A strategy targeting high-risk groups combined with current practice could be shown to be feasible, more efficient and cost-effective than current practice alone.Methods/DesignDICI-VIH (acronym for nurse-driven targeted HIV screening) is a multicentre, cluster-randomized, two-period crossover trial. The primary objective is to compare the effectiveness of 2 strategies for diagnosing HIV among adult patients visiting EDs: nurse-driven targeted HIV screening combined with current practice (physician-directed diagnostic testing) versus current practice alone. Main secondary objectives are to compare access to specialist consultation and how early HIV diagnosis occurs in the course of the disease between the 2 groups, and to evaluate the implementation, acceptability and cost-effectiveness of nurse-driven targeted screening. The 2 strategies take place during 2 randomly assigned periods in 8 EDs of metropolitan Paris, where 42 % of France’s new HIV patients are diagnosed every year. All patients aged 18 to 64, not presenting secondary to HIV exposure are included. During the intervention period, patients are invited to fill a 7-item questionnaire (country of birth, sexual partners and injection drug use) in order to select individuals who are offered a rapid test. If the rapid test is reactive, a follow-up visit with an infectious disease specialist is scheduled within 72 h. Assuming an 80 % statistical power and a 5 % type 1 error, with 1.04 and 3.38 new diagnoses per 10,000 patients in the control and targeted groups respectively, a sample size of 140,000 patients was estimated corresponding to 8,750 patients per ED and per period. Inclusions started in June 2014. Results are expected by mid-2016.DiscussionThe DICI-VIH study is the first large randomized controlled trial designed to assess nurse-driven targeted HIV screening. This study can provide valuable information on HIV screening in health care settings.Trial registrationClinicalTrials.gov: NCT02127424 (29 April 2014).

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“…Participants included GPs, nurse practitioners (NPs) and nurses (nurses were included because they take part in every consult at Homeless Healthcare, and their involvement has been shown to facilitate the implementation of opt-out HIV testing) (Leblanc et al 2015). In the first phase (March 2014-March 2015, the healthcare providers conducted HIV testing according to their usual practice.…”

Section: Methodsmentioning

confidence: 99%

‘We didn’t have to dance around it’: opt-out HIV testing among homeless and marginalised patients

Leidel

Leslie

Boldy

et al. 2017

Aust. J. Prim. Health

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The role of nurses in HIV screening in health care facilities: A systematic review

Cited by 14 publications

References 51 publications

Implementation of Nurse‐Driven HIV Screening Targeting Key Populations in Emergency Departments: A Multilevel Analysis From the DICI‐VIH Trial

Implementation of Nurse‐Driven HIV Screening Targeting Key Populations in Emergency Departments: A Multilevel Analysis From the DICI‐VIH Trial

The impact of nurse-driven targeted HIV screening in 8 emergency departments: study protocol for the DICI-VIH cluster-randomized two-period crossover trial

‘We didn’t have to dance around it’: opt-out HIV testing among homeless and marginalised patients

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