title: 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.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Kecojevic
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lyons
authors.forename: David
authors.initials: D
authors.lastname: Holtgrave
authors.forename: Gretchen
authors.initials: G
authors.lastname: Torres
authors.forename: James
authors.initials: J
authors.lastname: Heffelfinger
authors.forename: Jeremy
authors.initials: J
authors.lastname: Brown
authors.forename: Eileen
authors.initials: E
authors.lastname: Couture
authors.forename: Julianna
authors.initials: J
authors.lastname: Jung
authors.forename: Samantha
authors.initials: S
authors.lastname: Connell
authors.forename: Richard E
authors.initials: RE
authors.lastname: Rothman
mesh_terms: D042241:Early Diagnosis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D017144:Focus Groups; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D019538:Health Care Surveys; D006801:Humans; D015397:Program Evaluation; D011634:Public Health; D014481:United States / Q000453:epidemiology