Emergency provider attitudes and barriers to universal HIV testing in the emergency department.

BACKGROUND: The Centers for Disease Control and Prevention (CDC) recently published recommendations for routine, voluntary human immunodeficiency virus (HIV) testing of adults in all health care settings, including the emergency department (ED). STUDY OBJECTIVE: The objective of this study was to examine the willingness of ED providers to offer HIV testing, as well as their perceived barriers to implementation of these guidelines. METHODS: Before the establishment of a routine HIV testing program in the ED, a 21-item survey was used to assess ED providers' knowledge, attitudes, and perceived challenges to HIV testing. Six months after program initiation, the identical survey was re-administered to determine whether HIV testing program experience altered providers' perceptions. RESULTS: There were 108 of 146 (74%) providers who completed both the pre- and post-implementation surveys. Although the majority of emergency providers at 6 months were supportive of an ED-based HIV testing program (59/108 [55%]), only 38% (41/108) were willing to offer the HIV test most or all of the time. At 6 months, the most frequently cited barriers to offering a test were: inadequate time (67/108 [62%]), inadequate resources (65/108 [60%]), and concerns regarding provision of follow-up care (64/108 [59%]). CONCLUSIONS: After the implementation of a large-scale HIV testing program in an ED, the majority of emergency providers were supportive of routine HIV testing. Nevertheless, 6 months after program initiation, providers were still reluctant to offer the test due to persistent barriers. Further studies are needed to identify feasible implementation strategies that minimize barriers to routine HIV testing in the ED.

Multicenter study of knowledge about human papilloma virus and attitudes among emergency department patients.

STUDY OBJECTIVE: We sought to evaluate knowledge of human papilloma virus (HPV) and attitudes toward the HPV vaccine among emergency department (ED) patients. DESIGN: Cross-sectional survey. SETTING: Three Boston EDs. PARTICIPANTS: We enrolled consecutive patients during two 24-hour periods at each site. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Knowledge of HPV and attitudes toward the HPV vaccine. RESULTS: We enrolled 387 patients (81% of eligible). Overall, 242 (63%) participants had heard of HPV and 203 (52%) supported state-mandated vaccination. In the multivariate model, characteristics associated with lower awareness of HPV were: (1) older age (compared to age 18 - 26-years: OR 0.45 [95%CI, 0.20-0.99] for age 27-44 years, OR 0.26 [95%CI, 0.12-0.56] for age 45-64 years, and OR 0.10 [95%CI, 0.04-0.28] for age 65 year or older), (2) black race (compared to white: OR 0.31 [95%CI, 0.15-0.64]); and (3) lower annual household income (OR 0.39 [95%CI, 0.19-0.81] for $40,000 or less). Of those people who had heard of HPV, 82% knew of its relationship to cervical cancer, but only 61% thought it was a sexually transmitted disease (STD). Support for state-mandated vaccination was higher among participants who knew that HPV was an STD (OR 2.9 [95%CI 1.7-5.0]), but was not higher among those who had heard of HPV (OR 0.64 [95%CI 0.34-1.2]) or who knew that HPV causes cervical cancer (OR 0.85 [95%CI 0.45-1.6]). CONCLUSIONS: Support for state-mandated HPV vaccination appears to be driven more by the knowledge that HPV is an STD than by its role in cervical cancer. Awareness that HPV is transmitted through sexual activity does not decrease support for vaccination and may actually enhance it.

Implications and impact of the new US Centers for Disease Control and prevention HIV testing guidelines.

Of the 1.2 million Americans estimated to be living with HIV in the United States, approximately 250,000 are unaware of their diagnosis and therefore unable to access clinical care and life-sustaining treatment. The revised 2006 US Centers for Disease Control and Prevention's guidelines for HIV testing recommend universal, routine, and voluntary HIV screening in public and private health care settings for all adults and adolescents between 13 and 64 years old. These major revisions present new challenges for health care providers, hospitals, government agencies, and community advocacy groups. In this review, we discuss the important issues in diverse care venues such as opt-out testing, consent and confidentiality, barriers to treatment, and financial impact. The implications of the revised recommendations for HIV testing are addressed in the context of a fragmented, overstressed, underfunded US health care system.

Compliance with recommended cancer screening among emergency department patients: a multicenter survey.

OBJECTIVES: The objectives were to measure compliance with, and possible sociodemographic disparities for, cancer screening among emergency department (ED) patients. METHODS: This was a cross-sectional survey in three academic EDs in Boston. The authors enrolled consecutive adult patients during two 24-hour periods at each site. Self-reported compliance with standard recommendations for cervical, breast, testicular, and prostate cancer screening were measured. The chi-square test was used test to evaluate associations between demographic variables and cancer screening compliance. RESULTS: The authors enrolled 387 patients (81% of those eligible). The participants had a mean (+/- standard deviation) age of 44 (+/-18) years and were 52% female, 16% Hispanic, and 65% white. Sixty-seven percent (95% confidence interval [CI] = 60% to 73%) of all women reported Pap smear examinations in the past 3 years, 92% (95% CI = 85% to 96%) of women aged > or = 40 years reported clinical breast examinations, and 88% (95% CI = 81% to 94%) of women aged > or = 40 years reported mammography. Fifty-one percent (95% CI = 40% to 61%) of men aged 18-39 years reported testicular self-examinations, and among men aged > or = 40 years, 79% (95% CI = 69% to 87%) reported digital rectal examinations (DREs) and 51% (95% CI = 40% to 61%) reported prostate-specific antigen (PSA) testing. Racial and ethnic minorities reported slightly lower rates of clinical breast examinations and testicular self-examinations. CONCLUSIONS: Most women and a majority of men in our ED-based study were compliant with recommended measures of cervical, breast, testicular, and prostate cancer screening. No large sociodemographic disparities in our patient population were identified. Based on these data, and the many other pressing public health needs of our ED population, the authors would be reluctant to promote ED-based cancer screening initiatives at this time.