Less Encouraging Lessons From the Front Lines: Barriers to Implementation of an Emergency Department-Based HIV Screening Program

Abstract

We describe barriers to, and discuss recommendations for, implementing a limited emergency department (ED)-based HIV screening program. A pilot program was designed to study the feasibility of integrating HIV screening into ED care among patients aged 18 to 64 years at an urban academic emergency department with an annual census of 50,000 patients. During the first 12 weeks of the pilot program, 395 patients were screened. Of those, 2 (0.5%; 95% confidence interval 0.06% to 1.8%) received a positive test result for HIV. Both were contacted by telephone, and one was seen for result notification, posttest counseling, and further care in the local health department. Of the patients who received a negative test result, 98% were contacted about their results. We encountered numerous barriers to implementation, which we categorized as departmental, public health, legal, institutional, test limitations, and infrastructure. Understanding potential barriers and making plans for dealing with them are critical to the successful implementation of an HIV screening program in the ED.