title: HIV testing in emergency departments in the United States: a national survey.
abstract: OBJECTIVE
  In 2006, the Centers for Disease Control and Prevention (CDC) published recommendations for HIV testing in health care settings, calling for nontargeted opt-out rapid HIV screening in most settings, including emergency departments (EDs). Although a number of ED-based testing strategies exist, it is unclear to what extent they are used. The objective of this study is to survey academic and community EDs throughout the United States to determine ED-based HIV testing practices.
  
  
  METHODS
  This was a cross-sectional survey study of all academic EDs and a weighted random sample of all community-based EDs in the United States. A standardized survey instrument was developed and administered with an Internet-based survey platform, followed by direct contact and mail. The survey included domains related to perceived HIV testing barriers, whether HIV testing was performed and methods used, and familiarity with the CDC recommendations and whether they had been adopted.
  
  
  RESULTS
  Of the 131 total academic sites and the 435 community sites, 99 (76%) and 150 (35%) completed the survey, respectively. A larger proportion of academic sites believed HIV testing was needed (P=.02) and a larger proportion actually provided HIV testing (65% versus 50%; P=.04). Among the academic and community EDs that provided testing, 74% and 62% performed diagnostic testing, 26% and 22% performed targeted screening, and 16% and 6% performed nontargeted screening, respectively. A larger proportion of academic EDs reported receiving external funding to support testing (23% versus 4%; P=.001), whereas a large proportion of community sites considered costs a significant barrier to testing (P=.03). A larger proportion of academic EDs reported being familiar with the 2006 CDC recommendations (64% versus 40%; P<.001), although only 26% and 37% reported having implemented any part of them, respectively.
  
  
  CONCLUSIONS
  Academic EDs only make up approximately 3% of all EDs in the United States. Significant differences exist between academic and community EDs as they relate to performing HIV testing. Increased efforts should be made to improve the ability of community EDs to provide this service.
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO 80204, USA. Jason.Haukoos@dhha.org
authors.forename: Jason S
authors.initials: JS
authors.lastname: Haukoos
authors.forename: Emily
authors.initials: E
authors.lastname: Hopkins
authors.forename: Amber
authors.initials: A
authors.lastname: Hull
authors.forename: Christian
authors.initials: C
authors.lastname: Dean
authors.forename: Kevin
authors.initials: K
authors.lastname: Donahoe
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Ruzas
authors.forename: Jessica D
authors.initials: JD
authors.lastname: Bauerle
authors.forename: Brian
authors.initials: B
authors.lastname: Terrien
authors.forename: Jessica
authors.initials: J
authors.lastname: Forsyth
authors.forename: Brian
authors.initials: B
authors.lastname: Kalish
authors.forename: Mark
authors.initials: M
authors.lastname: Thrun
authors.forename: Richard
authors.initials: R
authors.lastname: Rothman
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D019983:Guideline Adherence; D015658:HIV Infections / Q000175:diagnosis*; D019538:Health Care Surveys; D006801:Humans; D014481:United States