title: A comparative evaluation of the process of developing and implementing an emergency department HIV testing program.
abstract: BACKGROUND
  The 2006 Centers for Disease Control and Prevention (CDC) HIV testing guidelines recommend screening for HIV infection in all healthcare settings, including the emergency department (ED). In urban areas with a high background prevalence of HIV, the ED has become an increasingly important site for identifying HIV infection. However, this public health policy has been operationalized using different models. We sought to describe the development and implementation of HIV testing programs in three EDs, assess factors shaping the adoption and evolution of specific program elements, and identify barriers and facilitators to testing.
  
  
  METHODS
  We performed a qualitative evaluation using in-depth interviews with fifteen 'key informants' involved in the development and implementation of HIV testing in three urban EDs serving sizable racial/ethnic minority and socioeconomically disadvantaged populations. Testing program HIV prevalence ranged from 0.4% to 3.0%.
  
  
  RESULTS
  Three testing models were identified, reflecting differences in the use of existing ED staff to offer and perform the test and disclose results. Factors influencing the adoption of a particular model included: whether program developers were ED providers, HIV providers, or both; whether programs took a targeted or non-targeted approach to patient selection; and the extent to which linkage to care was viewed as the responsibility of the ED. A common barrier was discomfort among ED providers about disclosing a positive HIV test result. Common facilitators were a commitment to underserved populations, the perception that testing was an opportunity to re-engage previously HIV-infected patients in care, and the support and resources offered by the medical setting for HIV-infected patients.
  
  
  CONCLUSIONS
  ED HIV testing is occurring under a range of models that emerge from local realities and are tailored to institutional strengths to optimize implementation and overcome provider barriers.
authors: San Francisco General Hospital HIV/AIDS Division, University of California San Francisco, San Francisco, CA, USA. christopoulosk@php.ucsf.edu
authors: Katerina A
authors: KA
authors: Christopoulos
authors: Kim
authors: K
authors: Koester
authors: Sheri
authors: S
authors: Weiser
authors: Tim
authors: T
authors: Lane
authors: Janet J
authors: JJ
authors: Myers
authors: Stephen F
authors: SF
authors: Morin
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D004636:Emergency Service, Hospital; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D015497:HIV-1 / Q000302:isolation & purification*; D006291:Health Policy; D006301:Health Services Needs and Demand; D006801:Humans; D008403:Mass Screening; D015995:Prevalence; D016730:Program Development; D015397:Program Evaluation; D011634:Public Health; D036301:Qualitative Research; D014342:Truth Disclosure; D014481:United States / Q000453:epidemiology; D014505:Urban Population