Patients' response to an emergency department-based HIV testing program and perception of their friends' attitudes on HIV testing among patients seeking care at an urban emergency department in Baltimore, Maryland, USA.

BACKGROUND: Little is known regarding the possible role of social network members and peer attitudes on emergency department (ED) patients' willingness to be tested for HIV. METHODS: We conducted mixed methods in-depth interview and quantitative survey with ED patients from November 2013 to June 2014 to assess peer and personal perceptions of ED-based HIV testing. Patients enrolled were asked about their own attitudes toward HIV testing as well as those of their friends. Interviews were transcribed and categories that captured free responses in the verbatim were independently coded by two reviewers. RESULTS: Overall, 86 patients were enrolled including 22 HIV known positive. Among 64 HIV-negative participants, 50 were tested during the past 12 months and 4 had never been tested. The majority (82.5%) of participants thought that their friends were likely to accept HIV testing in EDs. Participants discussed their perceptions of friends' attitudes toward HIV testing: the majority (60%) believed their friends held positive attitudes about HIV testing. The majority of participants believed that their friends had positive feelings about HIV testing and were likely to accept testing in ED settings. CONCLUSIONS: Interventions utilizing peer networks to promote HIV testing and increase testing acceptance could be designed and explored.

Linkage-to-care Methods and Rates in U.S. Emergency Department-based HIV Testing Programs: A Systematic Literature Review Brief Report.

BACKGROUND: An increasing number of U.S. emergency departments (EDs) have implemented ED-based HIV testing programs since the Centers for Disease Control and Prevention issued revised HIV testing recommendations for clinical settings in 2006. In 2010, the National HIV/AIDS Strategy (NHAS) set an linkage-to-care (LTC) rate goal of 85% within 90 days of HIV diagnosis. LTC rates for newly diagnosed HIV-infected patients vary markedly by site, and many are suboptimal. The optimal approach for LTC in the ED setting remains unknown. OBJECTIVE: The objective was to perform a brief descriptive analysis of the LTC methods practiced in EDs across the United States to determine the overall linkage rate of ED-based HIV testing programs. METHODS: We conducted a systematic review of literature related to U.S. ED HIV testing in the adult population using PubMed, Embase, Web of Science, Scopus, and Cochrane. There were 333 articles were identified; 31 articles were selected after a multiphasic screening process. We analyzed data from the 31 articles to assess LTC methods and rates. LTC methods that involved physical escort of the newly diagnosed patient to an HIV/infectious disease (ID) clinic or interaction with a specialist health care provider at the ED were operationally defined as "intensive" LTC protocol. "Mixed" LTC protocol was defined as a program that employed intensive linkage only part of the coverage hours. All other forms of linkage was defined as "nonintensive" LTC protocol. An LTC rate of ≥85% was used to identify characteristics of ED-based HIV testing program associated with a higher LTC rate. RESULTS: There were 37 ED-based HIV testing programs in the 31 articles. The overall LTC rate was 74.4%. Regarding type of protocol, nine (24.3%) employed intensive LTC protocols, 25 (67.6%) nonintensive, two (5.4%) mixed, and one (2.7%) with unclear protocols. LTC rates for programs with intensive and nonintensive LTC protocols were 80.0 and 72.7%, respectively. Four (44.4%) with intensive protocols and nine (36.0%) with the nonintensive protocols had LTC rates > 85%. The linkage staff employed was different between ED programs. Among them, 25 (67.6%) programs used exogenous staff, 10 (27.0%) used the ED staff, and two had no information. All the programs in the nonintensive group utilized drop-in HIV/ID clinic or medical appointments while seven of nine of the programs in the intensive group physically escorted the patients to the initial medical intake appointment. There were no significant differences in characteristics of ED-based HIV testing programs between those with ≥85% LTC rate versus those with <85% within the intensive or nonintensive group. CONCLUSION: Intensive LTC protocols had a higher LTC rate and a higher proportion of programs that surpassed the >85% NHAS goal compared to nonintensive methods, suggesting that, when possible, ED-based HIV testing programs should adopt intensive LTC strategies to improve LTC outcomes. However, intensive LTC protocols most often required involvement of multidisciplinary non-ED professionals and external research funding. Our findings provide a foundation for developing best practices for ED-based HIV LTC programs.