Factors Influencing Emergency Department Providers' HIV Testing Practices

Background

Despite recommendations for routine HIV screening by the Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF), providers in emergency departments (EDs) rarely test for HIV. This study assesses current HIV testing practices among providers in an urban academic ED and identifies factors that determine these practices.

Methods

A 24-item written questionnaire was administered to a convenience sample of providers (physicians, nurses, and medical students) in an urban academic ED. The survey evaluated current HIV testing practices, knowledge, attitudes, and barriers to HIV testing. Chi-square tests were used to examine associations between responses.

Results

A total of 137 ED providers completed the survey- 34.6% physicians, 33.8% nurses, and 31.6% medical students. 80.2% of providers reported ordering ≤5 HIV tests in the past 6 months, among whom 78% believed they tested with the same frequency as their colleagues.  The relationship between HIV testing practices and perceived testing practices of colleagues was statistically significant (p=0.0079). 

The survey showed that 61.2% of providers felt that HIV testing in the ED setting is part of their responsibility and 57.4% supported routine HIV testing in the ED. Despite positive attitudes towards routine testing, 84.6% reported they would rarely or occasionally offer an HIV test in the absence of an HIV testing program. There were no significant relationships found between providers’ HIV testing practices and their HIV testing knowledge, attitudes or perceived barriers to testing. 

Conclusion

Our data suggests that ED providers’ HIV testing practices are most influenced by the testing practices of colleagues and the existence of an HIV testing program. This suggests that in the absence of a structured HIV testing program, the uptake of the CDC and USPSTF routine HIV screening recommendations in the ED is unlikely. Additionally, establishing a ‘culture’ and expectation of HIV testing among colleagues could improve HIV screening practices in the ED.