Abstract
BackgroundHIV prevention is increasingly focused on people living with HIV (PLWH) and the role of healthcare settings in prevention. Emergency Departments (EDs) frequently care for PLWH, but do not typically endorse a prevention mission. We conducted a pilot exploratory evaluation of the first reported ED program to address the prevention needs of PLWH.MethodsThis retrospective observational cohort evaluation reviewed program records to describe the first six months of participants and programmatic operation. Trained counselors provided a risk assessment and counseling intervention combined with three linkage interventions: i) linkage to health care, ii) linkage to case management, and iii) linkage to partner counseling and referral.ResultsOf 81 self-identified PLWH who were approached, 55 initially agreed to participate. Of those completing risk assessment, 17/53 (32%, 95 CI 20% to 46%) reported unprotected anal/vaginal intercourse or needle sharing in the past six months with a partner presumed to be HIV negative. Counseling was provided to 52/53 (98%). For those requesting services, 11/15 (73%) were linked to healthcare, 4/23 (17%) were coordinated with case management, and 1/4 (25%) completed partner counseling and referral.ConclusionGiven base resources of trained counselors, it was feasible to implement a program to address the prevention needs for persons living with HIV in an urban ED. ED patients with HIV often have unmet needs which might be addressed by improved linkage with existing community resources. Healthcare and prevention barriers for PLWH may be attenuated if EDs were to incorporate CDC recommended prevention measures for healthcare providers.
Highlights
HIV prevention is increasingly focused on people living with HIV (PLWH) and the role of healthcare settings in prevention
Many people living with HIV (PLWH) continue to engage in high risk behavior [1,2,3,4,5,6,7,8], and transmission by PLWH who have been exposed to drug regimens accelerates drug resistance[9,10]
Our theoretical construct and justification for this intervention focused on the following: 1) PLWH who are without sufficient support services are at risk of transmitting HIV, 2) prevention of transmission by PLWH attenuates the spread of drug resistant strains, 3) PLWH without linkages to support services are likely to desire such connections and be able to benefit from them, 4) identification of PLWH in need of support services is not straight forward since agencies dedicated to PLWH are frequently unaware of those they are not serving, and 5) PLWH who do not perceive an availability of other resources are likely to seek support in Emergency Departments (EDs), when medical concerns arise
Summary
HIV prevention is increasingly focused on people living with HIV (PLWH) and the role of healthcare settings in prevention. The public health community is emphasizing the critical importance of prevention interventions among PLWH [11,12,13,14,15,16]. BMC Health Services Research 2007, 7:164 http://www.biomedcentral.com/1472-6963/7/164 ventions into the clinical care of HIV-infected patients, and the efficacy of provider delivered behavioral interventions is increasingly demonstrated[16,17]. Clinicians have been called on to screen for high-risk behaviors, to communicate and serially reinforce prevention messages, to refer patients for services such as substance abuse treatment, and to facilitate partner counseling and referral services [14]. With an expanding evidence base and promotion by public health authorities, clinician attention to prevention for PLWH may increase, but such progress could only affect those PLWH who are in a relationship with a care provider
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