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Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
23:56

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Published on: October 31, 2010

A provider participatory implementation model for HIV testing in an ED.

Jennifer C Chen1, Matthew Bidwell Goetz, Jamie E Feld

  • 1Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA.

The American Journal of Emergency Medicine
|September 10, 2010
PubMed
Summary

Implementing HIV rapid testing in emergency departments (EDs) is feasible. Engaging nurses in community-based participatory research improved staff acceptance of HIV screening for patients with limited primary care access.

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Area of Science:

  • Public Health
  • Infectious Disease Prevention
  • Health Services Research

Background:

  • Routine human immunodeficiency virus (HIV) screening is recommended for all adults by the Centers for Disease Control and Prevention.
  • Community-based participatory research (CBPR) principles involve stakeholders in research design and execution.
  • Integrating HIV rapid testing into emergency departments (EDs) addresses screening needs for diverse patient populations.

Purpose of the Study:

  • To explore the implementation process, facilitators, and barriers of HIV rapid testing in an ED setting.
  • To assess the feasibility of a CBPR approach involving nurses and physicians in HIV screening.
  • To evaluate strategies for increasing HIV testing rates within the ED.

Main Methods:

  • A CBPR model was employed, with nurses and physicians actively participating in HIV rapid test implementation.
  • Clinical champions were identified, and staff received training; physicians obtained consent, and nurses administered tests.
  • Testing rates were monitored via electronic medical records, and qualitative interviews with providers were conducted.

Main Results:

  • By week 15, 121 HIV tests were administered.
  • Adjustments to the testing protocol, prioritizing nonpeak hours based on nursing feedback, led to increased weekly test numbers.
  • Provider opinions varied, with 32% supporting diagnostic testing, 27% favoring the nonpeak hours model, 18% supporting nontargeted screening, and 18% preferring no testing or "other."
  • Key barriers included consent, documentation, time constraints, and perceived screening relevance to ED duties.
  • Facilitators included ease of testing, perceived patient risk, and adaptable screening based on patient volume.

Conclusions:

  • HIV rapid testing is feasible in an ED within the Veterans Hospital Administration system.
  • Involving nursing staff in CBPR implementation can enhance acceptance of nontargeted HIV screening.
  • This model can facilitate the delivery of preventive services to ED patients with limited access to primary care.