San Francisco General Hospital HIV/AIDS Division, University of California San Francisco, San Francisco, CA, USA.
Implement Sci. 2011 Mar 30;6:30. doi: 10.1186/1748-5908-6-30.
The 2006 Centers for Disease Control and Prevention (CDC) HIV testing guidelines recommend screening for HIV infection in all healthcare settings, including the emergency department (ED). In urban areas with a high background prevalence of HIV, the ED has become an increasingly important site for identifying HIV infection. However, this public health policy has been operationalized using different models. We sought to describe the development and implementation of HIV testing programs in three EDs, assess factors shaping the adoption and evolution of specific program elements, and identify barriers and facilitators to testing.
We performed a qualitative evaluation using in-depth interviews with fifteen 'key informants' involved in the development and implementation of HIV testing in three urban EDs serving sizable racial/ethnic minority and socioeconomically disadvantaged populations. Testing program HIV prevalence ranged from 0.4% to 3.0%.
Three testing models were identified, reflecting differences in the use of existing ED staff to offer and perform the test and disclose results. Factors influencing the adoption of a particular model included: whether program developers were ED providers, HIV providers, or both; whether programs took a targeted or non-targeted approach to patient selection; and the extent to which linkage to care was viewed as the responsibility of the ED. A common barrier was discomfort among ED providers about disclosing a positive HIV test result. Common facilitators were a commitment to underserved populations, the perception that testing was an opportunity to re-engage previously HIV-infected patients in care, and the support and resources offered by the medical setting for HIV-infected patients.
ED HIV testing is occurring under a range of models that emerge from local realities and are tailored to institutional strengths to optimize implementation and overcome provider barriers.
2006 年疾病控制与预防中心（CDC）艾滋病毒检测指南建议在所有医疗保健环境中筛查艾滋病毒感染，包括急诊部（ED）。在艾滋病毒高背景流行的城市地区，ED 已成为识别艾滋病毒感染的一个越来越重要的场所。然而，这项公共卫生政策是通过不同的模式来实施的。我们旨在描述三个 ED 中艾滋病毒检测计划的制定和实施，评估影响特定计划要素采用和演变的因素，并确定检测的障碍和促进因素。
我们使用深度访谈对十五名参与三个城市 ED 艾滋病毒检测开发和实施的“关键信息提供者”进行了定性评估，这些 ED 服务于相当数量的种族/族裔少数群体和社会经济弱势群体。检测计划的艾滋病毒流行率从 0.4%到 3.0%不等。
确定了三种检测模式，反映了在利用现有 ED 工作人员提供和进行检测以及披露结果方面的差异。影响特定模式采用的因素包括：项目开发者是 ED 提供者、艾滋病毒提供者还是两者兼有；计划是否采取有针对性或无针对性的方法选择患者；以及将联系护理视为 ED 的责任的程度。一个共同的障碍是 ED 提供者对披露艾滋病毒阳性检测结果感到不适。常见的促进因素包括对服务不足人群的承诺、认为检测是重新接触以前感染艾滋病毒的患者接受护理的机会、以及医疗环境为艾滋病毒感染者提供的支持和资源。
ED 艾滋病毒检测是在一系列模型下进行的，这些模型源自当地实际情况，并针对机构优势进行了调整，以优化实施并克服提供者的障碍。
