title: The role of nurses in HIV screening in health care facilities: A systematic review.
abstract: OBJECTIVE
  To examine nurse-driven HIV screening in various health care settings in terms of its impact on test offering, acceptance and delivery rates, nursing responsibilities, staff perceptions and long-term implementation.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  The systematic review conducted in September 2014 adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Two independent reviewers extracted and summarised the eligible studies using a standardised form.
  
  
  METHODS
  All studies published from 2004 to 2014 that explored nurse-driven HIV screening practice in health care facilities in countries with comparable concentrated HIV epidemics were included.
  
  
  METHODS
  MEDLINE, EBSCO CINAHL.
  
  
  RESULTS
  Overall, 30 quantitative, qualitative and mixed methods studies fulfilled the eligibility criteria. The studies showed a trend in higher test offering, better acceptance and higher delivery rates with the implementation of nurse-driven HIV screening. However, among the 23 studies (77%) that evaluated these aims, only 13 studies (56%) had a control group, and 4 studies (17%) were randomised controlled trials (RCT) in few centres (i.e., 1 or 2). In 2 studies that compared nurse-driven HIV test offering to physician intervention, the participation of nurses was higher than that of physicians (85% vs. 54%, p<0.001; 47% vs. 28%, p<0.05). In a third study, the intervention of a dedicated nurse increased the test offering from 96.5% to 99.5% (OR=7.27, 95% CI=1.02-316.9). Acceptance rates increased with the nurse intervention in 2 RCTs (75% vs. 71%, p=0.025; 45% vs. 19%, p<0.05) and in a cohort study (74.8% vs. 84.3%, OR=1.82, 95% CI=1.14-2.88), whereas it decreased in 2 other studies. The testing rates increased in 7 out of 10 studies, with a maximum absolute increase of 65.9%. Nurse-driven HIV screening was evaluated at the time of routine HIV screening implementation in 27 studies (90%) and provided nurses with new responsibilities in 9 studies (30%). The few studies (23%) that explored how health care professionals, including nurses, perceived the strategy showed that this approach was well received. However, several operational barriers, such as lack of time, prevented its long-term implementation.
  
  
  CONCLUSIONS
  The review supports the implementation of nurse-driven HIV screening. However, the evaluation of the impact of the nurse approach by RCTs was scarce, calling for additional research to better evaluate the impact of the nursing profession's contribution to HIV screening. Moreover, the perceptions of nurses and health care staff were seldom evaluated and require further exploration to improve nurse-driven HIV screening implementation.
authors.affiliation: Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris (CRC-Est), 184, rue du Faubourg Saint Antoine, 75012 Paris, France; Doctoral School of Public Health 420, Versailles Saint-Quentin University, Versailles, France; EA 3647, Versailles Saint-Quentin University, Versailles, France. Electronic address: judith.leblanc@sat.aphp.fr.
authors.forename: Judith
authors.initials: J
authors.lastname: Leblanc
authors.affiliation: AP-HP, Groupe Hospitalier des Hôpitaux Universitaires Centre Parisien, Paris, France. Electronic address: esperieburnet@gmail.com.
authors.forename: Espérie
authors.initials: E
authors.lastname: Burnet
authors.affiliation: Epidemiology and Population Health Research Center, Team 11 Inserm U1018, Villejuif, France. Electronic address: kayigan.wilson@inserm.fr.
authors.forename: Kayigan Wilson
authors.initials: KW
authors.lastname: D'Almeida
authors.affiliation: Epidemiology and Population Health Research Center, Team 11 Inserm U1018, Villejuif, France. Electronic address: france.lert@inserm.fr.
authors.forename: France
authors.initials: F
authors.lastname: Lert
authors.affiliation: AP-HP, Hôpital St Antoine, Department of Clinical Pharmacology, Clinical Research Center of East of Paris (CRC-Est), Paris, France; INSERM U-698, Paris, France; University Pierre et Marie Curie, Paris 6, Paris, France. Electronic address: tabassome.simon@chusa.jussieu.fr.
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.affiliation: AP-HP, Hôpital Raymond-Poincaré, Infectious disease department, Garches, France; EA 3647, Versailles Saint-Quentin University, Versailles, France. Electronic address: anne-claude.cremieux@rpc.aphp.fr.
authors.forename: Anne-Claude
authors.initials: AC
authors.lastname: Crémieux
mesh_terms: D015492:AIDS Serodiagnosis; D005602:France; D015658:HIV Infections / Q000175:diagnosis*; D006268:Health Facilities; D006801:Humans; D024802:Nurse's Role
keywords: Emergency service; HIV; Health care facilities, manpower and services; Nurse; Nursing; Review, systematic; Screening