Barriers and mitigating strategies to routine HIV screening in emergency departments: A national qualitative study

The goal of this study was to explore current barriers and mitigating strategies to routine HIV screening in emergency departments (EDs) using a national sample of ED leadership, including both physician and non-physician providers.

We employed an exploratory research design informed by the consolidated criteria for reporting qualitative research. Participants were recruited from a comprehensive database of US EDs, targeting directors from diverse urban, suburban and rural settings. Data were collected from semi-structured interviews conducted during May 2023 to July 2024. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

Twenty-one individuals participated in the study. Five key themes were identified: (1) The role of the ED within HIV screening; (2) Adequate resources and buy-in-from staff to administration-are crucial for successful screening programmes; (3) Institutional and structural determinants shape ED HIV screening; (4) HIV stigma persists; and (5) Operationalization of ED HIV testing is crucial. The participants highlighted the strategic potential of EDs for HIV screening, the need for institutional support and challenges posed by staffing, logistical issues and stigma.

This study provides an in-depth exploration of the barriers and mitigating strategies to HIV screening in US EDs through the lens of directors around the country. Despite the capacity and strategic potential of EDs to contribute to HIV prevention, significant challenges persist, including staffing, logistical issues and stigma. Institutional investment in staff support systems, integration of HIV screening into electronic medical records and efforts to normalize HIV screening are essential to enhance the efficacy of screening programmes.