Hospital-based routine HIV testing in high-income countries: a systematic literature review

Area of Science:

• Public Health
• Infectious Diseases
• Health Services Research

Background:

• Routine HIV testing in hospital settings like emergency departments (EDs) and acute medical units (AMUs) is a strategy to improve early diagnosis and treatment.
• Understanding barriers and facilitators is crucial for optimizing HIV testing programs in high-income countries.

Purpose of the Study:

• To systematically review published evidence on barriers and facilitators of hospital-based routine HIV testing in high-income countries.
• To identify factors influencing HIV testing uptake and coverage in EDs and AMUs.

Main Methods:

• A systematic literature search was conducted on electronic databases for studies published between 2006 and 2015.
• Included studies focused on HIV testing offers to adults in UK and US EDs/AMUs, assessing uptake, coverage, facilitators, and barriers.
• Fourteen studies were critically appraised using the Mixed Methods Appraisal Tool (MMAT).

Main Results:

• HIV testing coverage varied (9.7%-38.3% in the UK, 18.7%-26% in the US), while uptake was high (70.1%-84% UK, 53%-75.4% US).
• Operational barriers included staff time constraints, training needs, and concerns regarding result disclosure and follow-up.
• Patient factors like female sex, older age, and low perceived risk were associated with testing refusal.

Conclusions:

• Significant barriers hinder routine HIV testing in EDs and AMUs, often linked to healthcare staff's apprehension and knowledge gaps regarding HIV.
• Targeted interventions addressing staff concerns and operational challenges are needed to enhance routine HIV testing coverage.