Abstract
ObjectiveWe 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.MethodsEDs 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.ResultsIndigenous 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.ConclusionOur 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.
Highlights
Emergency Departments (EDs) provide care for high proportions of the populations in developed countries [1,2]
The paucity of evidence regarding the benefit of HIV nontargeted screening as a public health prevention strategy [15,16], or regarding the best approach to use while conducting such a screening [17],combined with the lack of funding might partly explain why HIV screening is not widely available in EDs [18,19]
Acceptance was similar (63%) in both groups of EDs whereas the offer rate was higher for the indigenous staff model (37% vs. 20%, P,.05) (Figure 1).The characteristics of the EDs sample are shown in table 1
Summary
Emergency Departments (EDs) provide care for high proportions of the populations in developed countries [1,2]. In addition to their primary acute-care role, EDs appear as potential places to provide preventive health care [3,4,5,6]. The paucity of evidence regarding the benefit of HIV nontargeted screening as a public health prevention strategy [15,16], or regarding the best approach to use while conducting such a screening [17],combined with the lack of funding might partly explain why HIV screening is not widely available in EDs [18,19]. In the settings where the implementation of HIV ED-based screening have been attempted, numerous barriers have been reported, including time constraints, inadequate resources, concerns regarding workloads or provision of follow up care [20]. HIV screening raises specific issues and legal concerns, such as the need for HIV screening programs to comply with HIV-test regulations [21] or the fact that some clinicians feel uncomfortable offering HIV testing and disclosing positive results [22]
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