title: Short communication routine HIV testing in the emergency department: assessment of patient perceptions.
abstract: The CDC released revised HIV testing guidelines in 2006 recommending routine, opt-out HIV testing in acute care settings including emergency departments (ED). Patient attitudes have been cited as a barrier to implementation of routine HIV testing in the ED. We assessed patients' perceptions of HIV testing in the ED through a contextual qualitative approach. The study was conducted during a 72-h period. All adults presenting to the ED without life-threatening trauma or psychiatric crisis completed a standardized questionnaire. The questionnaire explored HIV testing history, knowledge of testing resources, and qualitative items addressing participant perceptions about advantages and disadvantages to ED testing. After completion of the interview, participants were offered a free, confidential, rapid HIV test. Among 329 eligible individuals approached, 288 (87.5%) completed the initial interview. Participants overwhelmingly (n=247, 85.8%) reported support for testing and identified increased knowledge (41%), prevention (12.5%), convenience (11.8%), and treatment (4.9%) among the advantages. Fear and denial about one's HIV status, reported by <5% of patients, were identified as the most significant barriers to ED testing. Bivariate analysis determined race and ethnicity differences between individuals completing the interview and those who refused (p<0.05). Among individuals consenting for testing (n=186, 64.6%), no positives were detected. Most patients support HIV testing in the ED, noting knowledge of status, prevention, convenience, and linkage to early treatment as distinct advantages. These data are of particular benefit to decision makers considering the addition of routine HIV testing in EDs.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, USA. dsbatey@uab.edu
authors.forename: D Scott
authors.initials: DS
authors.lastname: Batey
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Hogan
authors.forename: Ryan
authors.initials: R
authors.lastname: Cantor
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Hamlin
authors.forename: Kelly
authors.initials: K
authors.lastname: Ross-Davis
authors.forename: Christa
authors.initials: C
authors.lastname: Nevin
authors.forename: Cindy
authors.initials: C
authors.lastname: Zimmerman
authors.forename: Shakira
authors.initials: S
authors.lastname: Thomas
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods*; D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology; D003142:Communication; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D057226:Information Seeking Behavior; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000523:psychology / Q000639:trends; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D012938:Social Perception; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult