Routine HIV testing in the Emergency Department: feasible and acceptable?

Routine HIV testing in non-specialist settings has the potential to significantly reduce late diagnosis and delay in treatment. The objective was to determine the feasibility and acceptability of HIV testing in an Emergency Department (ED) at a busy London teaching hospital. We conducted an observational cross sectional study between March-May 2012 where patients aged between 18-65 years attending St George's ED having serological tests were offered HIV testing by ED clinical staff. Patients were given an information leaflet on HIV, including how to obtain results. Data detailing whether the test was offered (feasibility) and whether the patient consented to the test (acceptability) were documented. Information regarding reasons for not offering HIV testing and reasons why the test was declined was also recorded. During the study period, 24,171 patients aged 18-65 were seen in the ED. Data were collected from 5657 patients. The mean age was 38 years, 57% were female and 27% identified themselves as white. 48% were offered HIV testing, of which 65% accepted. Incapacity to consent to testing was cited by clinicians as the commonest reason for not offering an HIV test (76%). 'Recent HIV test' was the commonest reason for declining a test (38%). One new HIV diagnosis was made. Our experience demonstrates that routine HIV testing in the ED is feasible and acceptable. However, to make HIV testing effective and part of routine clinical care, considerable clinical leadership, staff training and additional resources are required.