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McGregor AJ, Greenberg MR, Donnelly EA. Invited editorial: A guide to caring for patients who identify as transgender and gender diverse in the emergency department: The evolution of evidence-based medicine. J Am Coll Emerg Physicians Open 2024; 5:e13218. [PMID: 38903765 PMCID: PMC11187803 DOI: 10.1002/emp2.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 06/22/2024] Open
Affiliation(s)
- Alyson J. McGregor
- Department of Emergency MedicineUniversity of South Carolina School of MedicineGreenvilleSouth CarolinaUSA
| | - Marna Rayl Greenberg
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/USF Morsani College of Medicine, Lehigh CampusAllentownPennsylvaniaUSA
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Valero-Verdejo L, Hueso-Montoro C, Pérez-Morente MÁ. Evaluation of HIV screening in hospital emergency services. Systematic review. Int Emerg Nurs 2023; 71:101355. [PMID: 37852058 DOI: 10.1016/j.ienj.2023.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 08/28/2023] [Accepted: 09/10/2023] [Indexed: 10/20/2023]
Abstract
AIM To evaluate HIV screening of people attending emergency services. DESIGN Systematic review. DATA SOURCES CINAHL Complete, Cochrane Library, Cuiden Plus, PubMed, PsycINFO, SCOPUS and Web of Science. REVIEW METHODS The search was carried out between December 2020 and March 2021 following the recommendations set forth in the PRISMA declaration. The Mixed Methods Appraisal Tool (MMAT) was used to evaluate the methodological quality of studies. For data extraction, a protocol was prepared. A qualitative synthesis of the main findings was carried out. RESULTS The final sample consisted of 29 articles. There are several aspects that influence the performance of HIV screening in the emergency department, such as: adequacy of place, attitude towards screening, sociodemographic characteristics, risky sexual behaviour, incidence of area, and detection tools or method employed, in addition to other factors such as the stigma associated with the disease. CONCLUSIONS Emergency services are relevant in screening the human immunodeficiency virus. Further research aimed at creating new interventions allowing early detection and adherence to treatment in this population is still a need, particularly in a first-line service like emergency services.
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Affiliation(s)
| | - César Hueso-Montoro
- Faculty of Health Sciences, University of Jaén, Jaén, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Granada, Spain.
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3
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Rao A, Chen VH, Hill S, Reynolds SJ, Redd AD, Stead D, Hoffmann C, Quinn TC, Hansoti B. Changing HCW attitudes: a case study of normalizing HIV service delivery in emergency departments. BMC Health Serv Res 2022; 22:629. [PMID: 35546234 PMCID: PMC9097323 DOI: 10.1186/s12913-022-07942-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background Delays in the implementation of evidence-based practices are significant and ubiquitous, compromising health outcomes. Resistance to change is a key factor in hindering adoption and integration of new evidence-based interventions. This study seeks to understand the impact of exposure to HIV testing within a research context on provider attitudes towards HIV counselling and testing (HCT) in emergency departments (ED). Methods This is a pre-and-post study design measuring the effect of a new ED-based HCT intervention, conducted by lay counsellors, on provider attitudes in Eastern Cape, South Africa. A validated, anonymized, 7-item survey was self-completed by routine care providers (physicians, nurses, and case managers). Questions were scored on a 5-point Likert scale with 5 consistently reflecting a positive attitude. Mean scores were calculated for each question and compared using a two-sample t-test to assess change in sample means for attitudes among providers surveyed before and after the intervention. Results A total of 132 surveys were completed across three EDs. Majority of respondents were female (70.5%), 20–29 years old (37.9%), of African race (81.1%), nurses (39.4%), and practicing medicine for 0–4 years (37.9%). Pre-intervention, providers displayed a positive attitude towards ‘the benefit of offering ED-based HCT to patients’ (4.33), ‘the ED offering HCT’ (3.53), ‘all ED patients receiving HCT’ (3.42), ‘concern about patient reaction to HCT’ (3.26), and ‘comfort with disclosing HCT results’ (3.21); and a mildly negative attitude towards ‘only high-risk ED patients receiving HCT’ (2.68), and ‘the burden of offering HCT in a clinical environment’ (2.80). Post-intervention, provider attitudes improved significantly towards ‘all ED patients receiving HCT’ (3.86, p < 0.05), ‘only high-risk ED patients receiving HCT’ (2.30, p < 0.05), ‘the burden of offering HCT in a clinical environment’ (3.21, p < 0.05), and ‘comfort with disclosing HCT results’ (3.81, p < 0.05). Conclusions Controlled exposure to new practices with a structured implementation period can shift attitudes beginning a process of practice normalization. In our study, we observed improvements in provider attitudes regarding the benefits of HCT and the burden of offering HCT to all patients in the ED. Research activities may have a role in mitigating resistance to change and supporting intervention adoption.
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Affiliation(s)
- Aditi Rao
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Victoria H Chen
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah Hill
- Krieger School of Arts and Sciences, The Johns Hopkins University, Baltimore, MD, USA
| | - Steven J Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew D Redd
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Stead
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa.,Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, Eastern Cape, East London, South Africa
| | - Christopher Hoffmann
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas C Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bhakti Hansoti
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Rao A, Nagourney EM, Chen VH, Hill S, Klein EY, Whalen M, Quinn TC, Hansoti B. Assessing attitudes to ED-based HIV testing: Development of a short-structured survey instrument. PLoS One 2021; 16:e0252372. [PMID: 34043713 PMCID: PMC8158958 DOI: 10.1371/journal.pone.0252372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 05/15/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Emergency Department (ED)-based HIV counseling and testing (HCT) has had a significant impact on improving rates of HIV diagnosis and linkage to care. Unfortunately, expansion of this strategy to low- and middle-income countries has been limited. Successful implementation of ED-based HCT is dependent on patient and provider acceptance of the intervention, and their attitudes and pre-existing biases towards the disease. This study sought to develop validated survey instruments to assess attitudes towards ED-based HCT. METHODS This cross-sectional study surveyed patients and providers in three EDs in the Eastern Cape province, South Africa. A convenience sample of patients and providers in the ED were surveyed. Exploratory factor analysis was conducted using questions on attitudes to HIV testing to develop validated survey instruments. An ANOVA test assessed variance in attitudes towards HCT based on demographic variables collected. RESULTS A total of 104 patient and 132 provider surveys were completed. Exploratory factor analysis resulted in a 17- and 7-question attitudes survey for patients and providers, respectively. Overall, 92.3% of patients and 70.7% of providers supported ED-based HCT, however, both groups displayed only mildly positive attitudes. Questions representing 'confidentiality' and 'stigma around HIV testing' had the least positive influence on patients' overall attitudes. Questions representing 'comfort with HIV testing' had the least positive influence on providers' overall attitudes. CONCLUSION Our study demonstrated ED patients and providers are generally supportive of ED-based HCT. A validated survey instrument was able to provide a standardized approach to identify barriers to HCT implementation in an ED setting, across contexts. For successful implementation, behavioral interventions must focus on strengthening patient beliefs around confidentiality and the consent process, and providers' comfort levels with providing HIV testing services in the ED.
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Affiliation(s)
- Aditi Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Emily M. Nagourney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Victoria H. Chen
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, United States of America
| | - Sarah Hill
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, United States of America
| | - Eili Y. Klein
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Madeleine Whalen
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Thomas C. Quinn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Division of Intramural Research, National Institutes of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States of America
| | - Bhakti Hansoti
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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Swarts L, Lahri S, van Hoving DJ. The burden of HIV and tuberculosis on the resuscitation area of an urban district-level hospital in Cape Town. Afr J Emerg Med 2021; 11:165-170. [PMID: 33680739 PMCID: PMC7910156 DOI: 10.1016/j.afjem.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/23/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Many patients present to emergency centres with HIV and tuberculosis related emergencies. Little is known about the influence of HIV and tuberculosis on the resuscitation areas of district-level hospitals. The primary objective was to determine the burden of non-trauma patients with HIV and/or tuberculosis presenting to the resuscitation area of Khayelitsha Hospital, Cape Town. METHODS A retrospective analysis was performed on a prospectively collected observational database. A randomly selected 12-week sample of data from the resuscitation area was used. Trauma and paediatric (<13 years) cases were excluded. Patient demographics, HIV and tuberculosis status, disease category, investigations and procedures undertaken, disposition and in-hospital mortality were assessed. HIV and tuberculosis status were determined by laboratory confirmation or from clinical records. Descriptive statistics are presented and comparisons were done using the χ2-test or independent t-test. RESULTS A total of 370 patients were included. HIV prevalence was 38.4% (n = 142; unknown n = 78, 21.1%), tuberculosis prevalence 13.5% (n = 50; unknown n = 233, 63%), and HIV/tuberculosis co-infection 10.8% (n = 40). HIV and tuberculosis were more likely in younger patients (both p < 0.01) and more females were HIV-positive (p < 0.01). Patients with tuberculosis spend 93 min longer in the resuscitation area than those without (p = 0.02). The acuity of patients did not differ by HIV or tuberculosis status.Infectious-related diseases and diseases of the digestive system occurred significantly more in the HIV-positive group, and endocrine-related diseases and diseases of the nervous system in HIV-negative patients.HIV-positive patients received more abdominal ultrasound examinations (p < 0.01), blood cultures (p < 0.01) and intravenous antibiotics (p < 0.01). In-hospital mortality was 17% and was not influenced by HIV status (p = 0.36) or tuberculosis status (p = 0.29). CONCLUSION This study highlights the burden of HIV and tuberculosis on the resuscitation area of a district level hospital. Neither HIV nor tuberculosis status were associated with in-hospital mortality.
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Affiliation(s)
- Lynne Swarts
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Sa'ad Lahri
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Daniël J. van Hoving
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
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Wiskel T, Merchant R, Habet M, Mackey J. Developing an Accident and Emergency HIV Testing Program in Belize City: Recommendations from Key Stakeholders. J Int Assoc Provid AIDS Care 2020; 18:2325958219856328. [PMID: 31216941 PMCID: PMC6748511 DOI: 10.1177/2325958219856328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
With the ultimate goal of developing an accident and emergency (A&E) department HIV testing program in Belize City, Belize, we sought input from key stakeholders on program components and potential facilitators and barriers to HIV testing in emergency care. We conducted semistructured interviews among 4 key stakeholder groups at Karl Heusner Memorial Hospital Authority (KHMHA) in Belize City: (1) 20 A&E patients, (2) 5 A&E physicians, (3) 5 A&E nurses, and (4) 5 KHMHA administrators. We performed a qualitative content analysis of the interview transcripts and isolated important themes. Major themes included: (1) Patient selection: patients preferred to test all A&E patients. All other stakeholder groups preferred testing specific patient groups. (2) Training: Specific training should be completed for staff. (3) Confidentiality: integral for testing. (4) Facilitators and barriers: facilitators included respectful relationships, privacy, resources, coordination, and education. Barriers included stigmatization, patient willingness, inadequate resources, privacy, and testing biases.
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Affiliation(s)
- Tess Wiskel
- 1 TeamHealth Special Operations Emergency Medicine, Northeast Division, Bala Cynwyd, PA, USA
| | - Roland Merchant
- 2 Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Marta Habet
- 3 Department of Accident and Emergency Medicine, Karl Heusner Memorial Hospital, Belize City, Belize
| | - Joy Mackey
- 4 Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
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Ryan S, Hahn E, Rao A, Mwinnyaa G, Black J, Maharaj R, Mvandaba N, Nyanisa Y, Quinn TC, Hansoti B. The impact of HIV knowledge and attitudes on HIV testing acceptance among patients in an emergency department in the Eastern Cape, South Africa. BMC Public Health 2020; 20:1066. [PMID: 32631297 PMCID: PMC7339484 DOI: 10.1186/s12889-020-09170-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transmission of HIV in South Africa continues to be high due to a large proportion of individuals living with undiagnosed HIV. Uptake of HIV testing is influenced by a multitude of factors including the patient's knowledge and beliefs about HIV. METHODS This study sought to quantify the impact of knowledge and attitudes on HIV testing acceptance in an emergency department by co-administering a validated HIV knowledge and attitudes survey to patients who were subsequently offered HIV testing. RESULTS During the study period 223 patients were interviewed and offered HIV testing. Individuals reporting more negative overall attitudes (p = 0.006), higher levels of stigma to HIV testing (p < 0.001), and individuals who believed their test was confidential (p < 0.001) were more likely to accept an HIV test. CONCLUSIONS Interventions focused on improving patient perceptions around testing confidentiality will likely have the greatest impact on testing acceptance in the emergency department.
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Affiliation(s)
- Sofia Ryan
- The Johns Hopkins University, Baltimore, MD, USA.
| | - Elizabeth Hahn
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aditi Rao
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - George Mwinnyaa
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA
| | - John Black
- Department of Infectious Disease, Livingstone Hospital, Port Elizabeth, South Africa.,Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Roshen Maharaj
- Department of Emergency Medicine, Livingstone Hospital, Port Elizabeth, South Africa
| | - Nomzamo Mvandaba
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Yandisa Nyanisa
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Thomas C Quinn
- The Johns Hopkins University, Baltimore, MD, USA.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA
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Hansoti B, Mwinnyaa G, Hahn E, Rao A, Black J, Chen V, Clark K, Clarke W, Eisenberg AL, Fernandez R, Iruedo J, Laeyendecker O, Maharaj R, Mda P, Miller J, Mvandaba N, Nyanisa Y, Reynolds SJ, Redd AD, Ryan S, Stead DF, Wallis LA, Quinn TC. Targeting the HIV Epidemic in South Africa: The Need for Testing and Linkage to Care in Emergency Departments. EClinicalMedicine 2019; 15:14-22. [PMID: 31709410 PMCID: PMC6833451 DOI: 10.1016/j.eclinm.2019.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Eastern Cape province of South Africa has one of the highest burdens of HIV in the world. Emergency Departments (EDs) can serve as optimal clinical sites for the identification of new HIV infections and entry into care. We sought to determine the current burden of HIV disease among ED patients in the Eastern Cape. METHODS We conducted a prospective cross-sectional observational study in the EDs of three Hospitals in the Eastern Cape province of South Africa from June 2017 to July 2018. All adult, non-critical patients presenting to the ED were systematically approached and offered a Point-Of-Care (POC) HIV test in accordance with South African guidelines. All HIV-positive individuals had their blood tested for the presence of antiretroviral therapy (ART) and the presence of viral suppression (≤ 1000 copies/ml). HIV incidence was estimated using a multi-assay algorithm, validated for a subtype C epidemic. FINDINGS Of the 2901 patients for whom HIV status was determined (either known HIV-positive or underwent POC HIV testing), 811 (28.0%) were HIV positive, of which 234 (28.9%) were newly diagnosed. HIV prevalence was higher in Mthatha [34% (388/1134) at Mthatha Regional Hospital and 28% (142/512) at Nelson Mandela Academic Hospital], compared to Port Elizabeth [22% (281/1255) at Livingstone Hospital]. HIV incidence was estimated at 4.5/100 person-years (95% CI: 2.4, 6.50) for women and 1.5 (CI 0.5, 2.5) for men. Of all HIV positive individuals tested for ART (585), 54% (316/585) tested positive for the presence of ARTs, and for all HIV positive participants with viral load data (609), 49% (299/609) were found to be virally suppressed. INTERPRETATION Our study not only observed a high prevalence and incidence of HIV among ED patients but also highlights significant attrition along the HIV care cascade for HIV positive individuals. Furthermore, despite developing an optimal testing environment, we were only able to enrol a small sub-set of the ED population. Given the high HIV prevalence and high attrition in the ED population, HIV services in the ED should also develop strategies that can accommodate large testing volumes and ART initiation.
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Affiliation(s)
- Bhakti Hansoti
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
| | - George Mwinnyaa
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
| | - Elizabeth Hahn
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Aditi Rao
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
| | - John Black
- Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
- Department of Medicine, Livingstone Hospital, Stanford Road, Korsten, Port Elizabeth 6020, South Africa
| | - Victoria Chen
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Kathryn Clark
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
| | - William Clarke
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Anna L. Eisenberg
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
| | | | - Joshua Iruedo
- Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
| | - Oliver Laeyendecker
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
| | - Roshen Maharaj
- Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
- Department of Emergency Medicine, Livingstone Hospital, Stanford Road, Korsten, Port Elizabeth 6020, South Africa
| | - Pamela Mda
- Nelson Mandela Hospital Clinical Research Unit, Sisson St, Fort Gale, Mthatha 5100, South Africa
| | - Jernelle Miller
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Nomzamo Mvandaba
- Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
| | - Yandisa Nyanisa
- Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
| | - Steven J. Reynolds
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
| | - Andrew D. Redd
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
| | - Sofia Ryan
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
| | - David F. Stead
- Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
- Department of Medicine, Frere Hospital, Amalinda Main Rd, Braelyn, East London 5201, South Africa
| | - Lee A. Wallis
- Division of Emergency Medicine, University of Cape Town, Main Rd, Observatory, Cape Town 7925, South Africa
| | - Thomas C. Quinn
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr # 7A03, Bethesda, MD 20892, USA
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Whalen M, Mda P, Parrish A, Quinn TC, Rothman R, Stead D, Hansoti B. Implementing emergency department-based HIV testing in a low-resource setting: The value of a structured feasibility assessment tool. South Afr J HIV Med 2018; 19:793. [PMID: 30167338 PMCID: PMC6111602 DOI: 10.4102/sajhivmed.v19i1.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 04/17/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction HIV is a worldwide health problem with continuing high rates of new infections in many parts of the world. This lack of progress in decreasing overall incidence rates has sparked innovative HIV testing strategies, including expansion of testing into the emergency department (ED) setting. Emergency departments have been shown to be high-yield testing venues in the United States and other developed world settings. The feasibility of expanding public health HIV services in the ED in limited-resource countries is unclear. Methods We performed a cross-sectional feasibility assessment of a convenience sample of four hospitals in the Eastern Cape, South Africa. We administered three adapted interview tools from a previously field-tested survey instrument at each facility (total of 10 interviews) to gather an overview of the health facility, their HIV counselling and testing services, and their laboratory services. Results All of the health facilities had access to basic commodities such as water and electricity. Many had severe human resource limitations and provided care to wide population catchment areas. In addition, there was little integration of HIV testing into current daily ED operations. Hospital staff identified numerous barriers to future ED testing efforts. Conclusions Although control of the HIV epidemic requires innovative testing strategies and treatment, specific assessments are warranted on how to incorporate routine HIV testing into an acute care facility like the ED, which typically has many competing priorities. The use of a prospective structured tool incorporating both barriers and benefits can provide valuable field-tested guidance for increased programme planning for HIV testing.
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Affiliation(s)
| | - Pamela Mda
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, South Africa
| | - Andy Parrish
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, South Africa.,Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, South Africa
| | - Thomas C Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, United States.,Division of Infectious Diseases, Johns Hopkins School of Medicine, Unite States
| | - Richard Rothman
- Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, South Africa
| | - David Stead
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, South Africa.,Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, South Africa
| | - Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University, United States
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Hansoti B, Stead D, Parrish A, Reynolds SJ, Redd AD, Whalen MM, Mvandaba N, Quinn TC. HIV testing in a South African Emergency Department: A missed opportunity. PLoS One 2018; 13:e0193858. [PMID: 29534077 PMCID: PMC5849282 DOI: 10.1371/journal.pone.0193858] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 02/20/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND South Africa has the largest HIV epidemic in the world, with 19% of the global number of people living with HIV, 15% of new infections and 11% of AIDS-related deaths. Even though HIV testing is mandated in all hospital-based facilities in South Africa (SA), it is rarely implemented in the Emergency Department (ED). The ED provides episodic care to large volumes of undifferentiated who present with unplanned injury or illness. Thus, the ED may provide an opportunity to capture patients with undiagnosed HIV infection missed by clinic-based screening programs. METHODS AND FINDINGS In this prospective exploratory study, we implemented the National South African HIV testing guidelines (counselor initiated non-targeted universal screening with rapid point of care testing) for 24-hours a day at Frere Hospital in the Eastern Cape from September 1st to November 30th, 2016. The purpose of our study was to quantify the burden of undiagnosed HIV infection in a South African ED setting. Furthermore, we sought to evaluate the effectiveness of the nationally recommended HIV testing strategy in the ED. All patients who presented for care in the ED during the study period, and who were clinically stable and fully conscious, were eligible to be approached by HIV counseling and testing (HCT) staff to receive a rapid point-of-care HIV test. A total of 2355 of the 9583 (24.6%) patients who presented to the ED for care during the study period were approached by the HCT staff, of whom 1714 (72.8%) accepted HIV testing. There was a high uptake of HIV testing (78.6%) among a predominantly male (58%) patient group who mostly presented with traumatic injuries (70.8%). Four hundred (21.6%) patients were HIV positive, including 115 (6.2%) with newly diagnosed HIV infection. The overall prevalence of HIV infection was twice as high in females (29.8%) compared to males (15.4%). Both sexes had a similar prevalence of newly diagnosed HIV infection (6.0% for all females and 6.4% for all males) in the ED. CONCLUSIONS Overall there was high HIV testing acceptance by ED patients. A non-targeted testing approached revealed a high HIV prevalence with a significant burden of undiagnosed HIV infection in the ED. Unfortunately, a counselor-driven HIV testing approach fell short of meeting the testing needs in this setting, with over 75% of ED patients not approached by HCT staff.
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Affiliation(s)
- Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - David Stead
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
- Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, East London, Eastern Cape, South Africa
| | - Andy Parrish
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
- Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, East London, Eastern Cape, South Africa
| | - Steven J. Reynolds
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States of America
| | - Andrew D. Redd
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States of America
| | - Madeleine M. Whalen
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Nomzamo Mvandaba
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Thomas C. Quinn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States of America
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