Implementing Rapid HIV Testing In Emergency Department
In 2006, the Centers for Disease Control and Prevention (CDC) recommended that HIV testing be offered to adults aged 13-64 in all healthcare settings, including the emergency department (ED). Since then, EDs throughout the United States have begun to implement rapid testing programs as a public health screening service. In the absence of guidelines on how to implement these recommendations into clinical practice, researchers from Brigham and Women's Hospital (BWH) have outlined a framework of lessons learned during the establishment of a rapid HIV testing program in an academic teaching hospital. These findings are published online in the International Journal of Emergency Medicine.
"Although at times challenging, we believe that routine HIV screening in the ED is feasible with appropriate infrastructure and with longitudinal and financial support. We offer this framework so that others both domestically and internationally who are poised to embark on HIV testing programs may benefit from our experiences," said Christian Arbelaez, MD, MPH, of the BWH Department of Emergency Medicine, Assistant Professor of Medicine at Harvard Medical School and lead author of the paper.
Researchers implemented this program over the course of a year which included time for advanced planning, piloting, and continuous refinement of programmatic details. Highlights of the framework identified in creating a successful HIV testing program in the emergency department included: identifying a champion, performing a needs assessment, engaging a comprehensive team, selecting an appropriate HIV test, establishing proper protocols and quality assurance measures, and providing education and training for the providers.
"While we have found that it is entirely possible to develop an HIV screening program in an emergency department, we have also experienced the challenges that arise along the road to implementation. Developing an interdisciplinary team of supportive clinical and administrative staff is a critical step in the success of this public health service," said Rochelle P. Walensky, MD, MPH, of the BWH and Massachusetts General Hospital (MGH) Divisions of Infectious Disease, Associate Professor of Medicine at Harvard Medical School, senior author of the study.
"We hope that components of this program will serve as a model and preliminary guidance for EDs throughout the United States. In international settings, many of the recommendations may also be applied, with careful attention to country- and setting-specific details." said Arbelaez.