title: Emergency provider attitudes and barriers to universal HIV testing in the emergency department.
abstract: BACKGROUND
  The Centers for Disease Control and Prevention (CDC) recently published recommendations for routine, voluntary human immunodeficiency virus (HIV) testing of adults in all health care settings, including the emergency department (ED).
  
  
  OBJECTIVE
  The objective of this study was to examine the willingness of ED providers to offer HIV testing, as well as their perceived barriers to implementation of these guidelines.
  
  
  METHODS
  Before the establishment of a routine HIV testing program in the ED, a 21-item survey was used to assess ED providers' knowledge, attitudes, and perceived challenges to HIV testing. Six months after program initiation, the identical survey was re-administered to determine whether HIV testing program experience altered providers' perceptions.
  
  
  RESULTS
  There were 108 of 146 (74%) providers who completed both the pre- and post-implementation surveys. Although the majority of emergency providers at 6 months were supportive of an ED-based HIV testing program (59/108 [55%]), only 38% (41/108) were willing to offer the HIV test most or all of the time. At 6 months, the most frequently cited barriers to offering a test were: inadequate time (67/108 [62%]), inadequate resources (65/108 [60%]), and concerns regarding provision of follow-up care (64/108 [59%]).
  
  
  CONCLUSIONS
  After the implementation of a large-scale HIV testing program in an ED, the majority of emergency providers were supportive of routine HIV testing. Nevertheless, 6 months after program initiation, providers were still reluctant to offer the test due to persistent barriers. Further studies are needed to identify feasible implementation strategies that minimize barriers to routine HIV testing in the ED.
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Arbelaez
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Wright
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Millen
authors.forename: Simeon
authors.initials: S
authors.lastname: Kimmel
authors.forename: Matthew
authors.initials: M
authors.lastname: Dooley
authors.forename: William M
authors.initials: WM
authors.lastname: Reichmann
authors.forename: Regina
authors.initials: R
authors.lastname: Mikulinsky
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods / Q000706:statistics & numerical data; D000328:Adult; D001291:Attitude of Health Personnel; D004636:Emergency Service, Hospital; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult