title: Ethical, financial, and legal considerations to implementing emergency department HIV screening: a report from the 2007 conference of the National Emergency Department HIV Testing Consortium.
abstract: OBJECTIVE
  We seek to identify and analyze, from a group of participants experienced with HIV screening, the perceived challenges and solutions to the ethical, financial, and legal considerations of emergency department (ED)-based HIV screening.
  
  
  METHODS
  We performed a qualitative analysis of the focus group discussions from the ethical, financial, and legal considerations portion of the inaugural National Emergency Department HIV Testing Consortium conference. Four groups composed of 20 to 25 consortium participants engaged in semistructured, facilitated focus group discussions. The focus group discussions were audiotaped and transcribed. A primary reader identified major themes and subthemes and representative quotes from the transcripts and summarized the discussions. Secondary and tertiary readers reviewed the themes, subthemes, and summaries for accuracy.
  
  
  RESULTS
  The focus group discussions centered on the following themes. Ethical considerations included appropriateness of HIV screening in the ED and ethics of key elements of the 2006 Centers for Disease Control and Prevention HIV testing recommendations. Financial considerations included models of payment and support, role of health care insurance, financial ethics and downstream financial burdens, and advocacy approaches. Legal considerations included the adequacy of obtaining consent, partner notification, disclosure of HIV results, difficulties in addressing special populations, failure of not performing universal screening, failure to notify a person of being tested, failure to notify someone of their test results, liability of inaccurate tests, and failure to link to care.
  
  
  CONCLUSIONS
  This qualitative analysis provides a broadly useful foundation to the ethical, financial, and legal considerations of implementing HIV screening programs in EDs throughout the United States.
authors.affiliation: Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA. mwaxman@hotmail.com
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Waxman
authors.forename: Rachel S
authors.initials: RS
authors.lastname: Popick
authors.forename: Roland C
authors.initials: RC
authors.lastname: Merchant
authors.forename: Richard E
authors.initials: RE
authors.lastname: Rothman
authors.forename: Judy B
authors.initials: JB
authors.lastname: Shahan
authors.forename: Gregory
authors.initials: G
authors.lastname: Almond
mesh_terms: D015492:AIDS Serodiagnosis / Q000191:economics / Q000941:ethics / Q000331:legislation & jurisprudence; D016358:Contact Tracing / Q000941:ethics / Q000331:legislation & jurisprudence; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000191:economics / Q000941:ethics / Q000331:legislation & jurisprudence; D017144:Focus Groups; D015658:HIV Infections / Q000175:diagnosis; D017721:Hospital Costs; D006801:Humans; D007258:Informed Consent / Q000941:ethics / Q000331:legislation & jurisprudence; D019458:Insurance Coverage; D008403:Mass Screening / Q000191:economics / Q000941:ethics / Q000331:legislation & jurisprudence; D017410:Practice Guidelines as Topic; D014481:United States