Public Health and Clinical Impact of Increasing Emergency Department–Based HIV Testing: Perspectives From the 2007 Conference of the National Emergency Department HIV Testing Consortium

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• 作者：Aleksandar Kecojevic MPH^a ; ^{ak955@drexel.edu"" rel=""nofollow} ; Christopher J. Lindsell PhD^b ; Michael S. Lyons MD^b ; David Holtgrave PhD^c ; Gretchen Torres MPP^d ; James Heffelfinger MD^e ; Jeremy Brown MD^f ; Eileen Couture DO ; MS^g ; Julianna Jung MD^a ; Samantha Connell BA^a ; Richard E. Rothman MD ; PhD^a ; National Emergency Department HIV Testing Consortium
• 刊名：Annals of Emergency Medicine
• 出版年：2011
• 出版时间：July 2011
• 年：2011
• 卷：58
• 期：1,
• 页码：S151-S159.e1
• 全文大小：310 K

文摘

Objective

Understanding perceived benefits and disadvantages of HIV testing in emergency departments (EDs) is imperative to overcoming barriers to implementation. We codify those domains of public health and clinical care most affected by implementing HIV testing in EDs, as determined by expert opinion.

Methods

Opinions were systematically collected from attendees of the 2007 National ED HIV Testing Consortium meeting. Structured evaluation of strengths, weaknesses, opportunities, and threats analysis was conducted to assess the impact of ED-based HIV testing on public health. A modified Delphi method was used to assess the impact of ED-based HIV testing on clinical care from both individual patient and individual provider perspectives.

Results

Opinions were provided by 98 experts representing 42 academic and nonacademic institutions. Factors most frequently perceived to affect public health were (strengths) high volume of ED visits and high prevalence of HIV, (weaknesses) undue burden on EDs, (opportunities) reduction of HIV stigma, and (threats) lack of resources in EDs. Diagnostic testing and screening for HIV were considered to have a favorable impact on ED clinical care from both individual patient and individual provider perspectives; however, negative test results were not perceived to have any benefit from the provider's perspective. The need for HIV counseling in the ED was considered to have a negative impact on clinical care from the provider's perspective.

Conclusion

Experts in ED-based HIV testing perceived expanded ED HIV testing to have beneficial impacts for both the public health and individual clinical care; however, limited resources were frequently cited as a possible impediment. Many issues must be resolved through further study, education, and policy changes if the full potential of HIV testing in EDs is to be realized.