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A comparative evaluation of the process of developing and implementing an emergency department HIV testing program.
Katerina A Christopoulos1, Kim Koester, Sheri Weiser
1San Francisco General Hospital HIV/AIDS Division, University of California San Francisco, San Francisco, CA, USA. christopoulosk@php.ucsf.edu
Implementation Science : IS
|April 1, 2011
Summary
Emergency department (ED) HIV testing programs vary in their operational models. Successful implementation hinges on local context, provider training, and addressing barriers like result disclosure to improve HIV identification and care.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Healthcare Management
Background:
- The Centers for Disease Control and Prevention (CDC) recommends HIV screening in all healthcare settings, including emergency departments (EDs).
- Urban EDs are crucial for identifying HIV infections due to high prevalence rates.
- Diverse models are used to implement HIV testing policies in EDs.
Purpose of the Study:
- To describe the development and implementation of HIV testing programs in three urban EDs.
- To assess factors influencing the adoption and evolution of HIV testing program elements.
- To identify barriers and facilitators to HIV testing in the ED setting.
Main Methods:
- Qualitative evaluation using in-depth interviews with 15 key informants.
- Study focused on three urban EDs serving minority and disadvantaged populations.
- HIV prevalence in testing programs ranged from 0.4% to 3.0%.
Main Results:
- Three distinct HIV testing models were identified, differing in staff roles for testing and result disclosure.
- Model adoption was influenced by provider background, testing approach (targeted vs. non-targeted), and linkage-to-care responsibility.
- Barriers included provider discomfort with positive result disclosure; facilitators included commitment to underserved populations and re-engagement of patients in care.
Conclusions:
- HIV testing in EDs operates under various models adapted to local conditions and institutional capabilities.
- Implementation strategies are tailored to optimize program effectiveness and overcome provider-related challenges.
- Successful ED HIV testing requires flexible models that leverage institutional strengths and address specific barriers.
