Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Blood Borne and SexuallyTransmitted Infections, London, UK.
BMJ Open. 2019 May 1;9(4):e024085. doi: 10.1136/bmjopen-2018-024085.
Increased test uptake for HIV and viral hepatitis is fast becoming a health priority at both national and global levels. Late diagnosis of these infections remains a critical public health concern in the UK. Recommendations have been issued to expand blood-borne virus (BBV) testing in alternative settings. Emergency departments (EDs) offer a potentially important point of testing. This paper presents findings from a qualitative study which aimed to explore the acceptability and feasibility of a routine opt-out combined BBV testing intervention implemented at an inner London ED.
We conducted 22 semistructured interviews with patients and service providers in the ED over a 4-month period during the intervention pilot. A grounded analytical approach was employed to conduct thematic analysis of qualitative study data.
Core interrelating thematic areas, identified and analytically developed in relation to test intervention implementation and experience, included the following: the remaking of routine test procedure; notions of responsibility in relation to status knowledge and test engagement; the opportunity and constraints of the ED as a site for testing; and the renegotiation of testing cultures within and beyond the clinic space.
Study findings demonstrate how relational and spatial dynamics specific to the ED setting shape test meaning and engagement. We found acceptability of the test practice was articulated through narratives of situated responsibility, with the value of the test offset by perceptions of health need and justification of the test expense. Participant accounts indicate that the nontargeted approach of the test affords a productive disruption to 'at-risk' identities, yet they also reveal limits to the test intervention's 'normalising' effect. Evaluation of the intervention must attend to the situated dynamics of the test practice if opportunities of an opt-out BBV test procedure are to be fully realised. Findings also highlight the critical need to further evaluate post-test intervention practices and experiences.
在国家和全球层面上，提高艾滋病毒和病毒性肝炎检测率正迅速成为一项健康重点。这些感染的晚期诊断仍然是英国公共卫生的一个重要关注点。已经发布了建议，以扩大在替代环境中进行血液传播病毒（BBV）检测。急诊部门（ED）提供了一个潜在的重要检测点。本文介绍了一项定性研究的结果，该研究旨在探索在伦敦市内部的 ED 实施常规选择性联合 BBV 检测干预措施的可接受性和可行性。
在干预试点期间的 4 个月内，我们在 ED 中对患者和服务提供者进行了 22 次半结构化访谈。采用扎根分析方法对定性研究数据进行主题分析。
与测试干预实施和经验相关的核心相互关联的主题领域包括以下内容：常规测试程序的重新制定；与状态知识和测试参与有关的责任观念；ED 作为检测地点的机会和限制；以及在诊所内外重新协商检测文化。
研究结果表明，ED 环境特有的关系和空间动态如何塑造测试的意义和参与度。我们发现，测试实践的可接受性是通过情境责任的叙述来表达的，测试的价值被健康需求的感知和测试费用的合理性所抵消。参与者的说法表明，测试的非针对性方法为“高危”身份提供了富有成效的干扰，但也揭示了测试干预的“正常化”效果的局限性。如果要充分实现 BBV 测试程序的选择性测试，那么必须关注测试实践的情境动态。研究结果还突出表明，迫切需要进一步评估检测后干预措施的实践和经验。
