title: A provider participatory implementation model for HIV testing in an ED.
abstract: BACKGROUND
  The Centers for Disease Control and Prevention recommends routine HIV screening for adults.
  
  
  OBJECTIVE
  Community-based participatory research incorporates subjects in the design and conduct of research. We included nurses and physicians in the implementation of HIV rapid test use in the emergency department (ED). We explored the process, facilitators, and barriers.
  
  
  METHODS
  We identified clinical champions and trained staff. Physicians obtained consent and ordered HIV testing; nurses performed rapid testing. Testing rates were tracked by electronic medical record. We conducted regular meetings between staff and researchers. Semistructured qualitative interviews with providers were conducted at 3 months.
  
  
  RESULTS
  By week 15, we administered 121 tests. After the eligibility protocol evolved to incorporate ED nursing concerns regarding staffing limitations from a random sampling model to one focused on testing during nonpeak hours, the weekly number of tests increased. Eighteen percent of providers favored nontargeted HIV screening, 27% favored the current model of testing at nonpeak hours, 32% supported diagnostic testing, and 18% favored no testing or "other." Barriers include written consent, electronic documentation, time constraints, and belief that screening is not a core ED duty. Facilitators include ease of test administration, belief that ED patients are at higher risk, and flexibility to tailor screening efforts according to patient volume.
  
  
  CONCLUSIONS
  The ED-based HIV testing is feasible within a Veterans Hospital Administration setting. Involvement of nursing in a community-based participatory research implementation model may facilitate staff acceptance of nontargeted HIV screening and be a mechanism to initiate administration of clinical preventive services to ED patients with limited primary care contact.
authors.affiliation: Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Chen
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.forename: Jamie E
authors.initials: JE
authors.lastname: Feld
authors.forename: Anne
authors.initials: A
authors.lastname: Taylor
authors.forename: Henry
authors.initials: H
authors.lastname: Anaya
authors.forename: Jane
authors.initials: J
authors.lastname: Burgess
authors.forename: Richard de Mesa
authors.initials: Rde M
authors.lastname: Flores
authors.forename: Risha A
authors.initials: RA
authors.lastname: Gidwani
authors.forename: Herschel
authors.initials: H
authors.lastname: Knapp
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Ocampo
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002985:Clinical Protocols; D015331:Cohort Studies; D055812:Community-Based Participatory Research; D004636:Emergency Service, Hospital; D015658:HIV Infections / Q000175:diagnosis*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006786:Hospitals, Urban; D006787:Hospitals, Veterans; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration*; D008875:Middle Aged; D015397:Program Evaluation; D055815:Young Adult