"How much more on the nurse?:" a qualitative analysis of inpatient nurses' perspectives on offering HIV testing

The CDC recommends that all individuals who are hospitalized be offered HIV testing. Low HIV testing rates have been reported among hospitalized patients. We investigated expanding HIV testing among hospitalized patients at our medical center, and hospital leadership consistently recommended exploring nursing-driven, universal HIV testing. The goal of this study was to use qualitative methods to evaluate Tufts Medical Center inpatient nurses' perspectives about the barriers and facilitators of implementing an inpatient nursing-based HIV testing protocol.

The study employed a qualitative research design through in-depth interviews and focus groups; these guides were developed based on Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Any inpatient nurse employed at Tufts Medical Center in January 2023 was eligible to participate, including case managers and travel nurses. Nurses were recruited through in-person recruitment, email, or flyers.

42 inpatient nurses participated in ten focus groups and two interviews. Eight primary themes emerged that were categorized into barriers and facilitators/strategies. The barriers were (1) concern that HIV testing would increase the nurse charting burden, (2) belief that HIV testing is not a priority for hospitalized patients, (3) concern that HIV testing consent is outside the scope of nursing practice, (4) misinformation about the required HIV testing consenting process, and (5) concern about offending patients. The facilitators/strategies were (6) belief that HIV testing is necessary for personal health, beneficial to public health and necessary for occupational safety; (7) ability to leverage existing systems of care support to HIV testing; and (8) ability to leverage current systems of education to increase HIV testing. Results showed that fostering trust within treatment teams and between patients and nurses would enable nurses to obtain patient consent for HIV testing without fear of negative consequences.

While nurses have concerns about offering HIV testing to all hospitalized patients, there are existing systems that can be leveraged to make implementing of universal, nursing-driven HIV testing acceptable and sustainable; these include protocolization; engagement and trust; and nursing champions of expanding HIV testing.