title: Understanding providers' offering and patients' acceptance of HIV screening in emergency departments: a multilevel analysis. ANRS 95008, Paris, France.
abstract: OBJECTIVE
  We assessed the EDs' characteristics associated with the offer and acceptance rates of a nontargeted HIV rapid-test screening in 29 Emergency Departments (EDs) in the metropolitan Paris region (11.7 million inhabitants), where half of France's new HIV cases are diagnosed annually.
  
  
  METHODS
  EDs nurses offered testing to all patients 18-64-year-old, able to provide consent, either with or without supplemental staff (hybrid staff model or indigenous staff model). The EDS' characteristics collected included structural characteristics (location, type, size), daily workload (patients' number and severity, length of stay in hours), staff's participation (training, support to the intervention, leadership), type of week day (weekends vs weekdays) and time (in days). Associations between these variables and the staff model, the offer and acceptance rates were studied using multilevel modeling.
  
  
  RESULTS
  Indigenous staff model was more frequent in EDs with a lower daily patient flow and a higher staff support score to the intervention. In indigenous-model EDs, the offer rate was associated with the patient flow (OR = 0.838, 95% CI = 0.773-0.908), was lower during weekends (OR = 0.623, 95% CI = 0.581-0.667) and decreased over time (OR = 0.978, 95% CI = 0.975-0.981). Similar results were found in hybrid-model EDs. Acceptance was poorly associated with EDs characteristics in indigenous-model EDs while in hybrid-model EDs it was lower during weekends (OR = 0.713, 95% CI = 0.623-0.816) and increased after the first positive test (OR = 1.526, 95% CI = 1.142-2.038). The EDs' characteristics explained respectively 38.5% and 15% of the total variance in the offer rate across indigenous model-EDs and hybrid model-EDs vs 12% and 1% for the acceptance rate.
  
  
  CONCLUSIONS
  Our findings suggest the need for taking into account EDs' characteristics while considering the implementation of an ED-based HIV screening program. Strategies allowing the optimization of human resources' utilization such as HIV targeted screening in the EDs might be privileged.
authors: INSERM U1018, Centre de recherche en épidémiologie et santé des populations, Villejuif, France. kayigan.wilson@inserm.fr
authors: Kayigan Wilson
authors: KW
authors: d'Almeida
authors: Dominique
authors: D
authors: Pateron
authors: Gérald
authors: G
authors: Kierzek
authors: Bertrand
authors: B
authors: Renaud
authors: Caroline
authors: C
authors: Semaille
authors: Pierre
authors: P
authors: de Truchis
authors: François
authors: F
authors: Simon
authors: Judith
authors: J
authors: Leblanc
authors: France
authors: F
authors: Lert
authors: Stéphane
authors: S
authors: Le Vu
authors: Anne-Claude
authors: AC
authors: Crémieux
mesh_terms: D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005602:France; D006678:HIV / Q000201:enzymology; D015658:HIV Infections / Q000175:diagnosis*; D054303:HIV Reverse Transcriptase / Q000032:analysis; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D054303:HIV Reverse Transcriptase
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