Less Encouraging Lessons from the Front Lines: Barriers to Implementation of an Emergency Department-Based HIV Screening Program, B.Mumma and B.Suffoletto, Annals of Emergency Medicine (2011)

This study outlines results from a pilot program to integrate HIV screening into emergency department care. The authors encountered significant barriers to the screening program and, in this paper, make recommendations to address those barriers.

The pilot program screened 395 patients for HIV at an urban academic emergency department over the course of 12 weeks. Researchers obtained signed informed consent from the patients, who also were required to complete a confidential survey and underwent oral and written pretest HIV counseling. Two of those screened received a positive HIV test result and were contacted by telephone. One was seen for result notification and further care and counseling. Negative test results were communicated by telephone, e-mail, or postal mail.

Researchers encountered significant obstacles to implementing the pilot program, pointing at a general lack of awareness and activism around HIV in their community as a central concern.

They had difficulty securing cooperation from the emergency department staff members, recommending that leaders within the department should champion screening and motivate others. Another barrier was the lack of resources to follow up with patients who tested negative. Researchers also received conflicting interpretations of state HIV testing and confidentiality law from the in-house and health department experts whom they consulted. Additionally, Institutional Review Board members raised subject risks in the area of informed consent that researchers had not previously considered. The researchers also struggled with testing limitations, weighing the value of more accurate but slower results against far quicker, but less accurate, rapid testing, Finally, the authors highlighted a number of infrastructural problems, including a lack of adequate staff and clinician time required for a successful screening program.

Researchers did characterize their implementation of the pilot HIV screening program as a success despite these barriers, but stressed that organizing a universal screening program in emergency departments would first require addressing these barriers.