Assess Your Readiness: Patient Selection

What patient population do you aim to reach with HIV testing in the ED?

• All patients in the ED?
• All patients in a particular area, such as urgent care or fast track?
• All patients with unknown HIV status?
• Anyone who wants a test?
• Patients presenting with sexually transmitted infections (STI)?
• Patients who present with symptoms, risk behaviors, or medical histories that may indicate HIV infection/AIDS?
• Other?

The goal of the effort, along with the characteristics of the patient population, HIV (and other STI) prevalence, and the human and financial resources available for HIV testing, will inform which testing approach is the most practical for your ED.  For more information on testing approaches, click here.  For guidance on how to set up your program so you can measure your progress and success, go here.

Testing Approaches	May require additional staffing	Pilot recommended	Requires linking to care	Better for limited resources	Communities with <1% prevalence	Communities with >1% prevalence
Diagnostic testing
Targeted testing
Screening or universal testing

To ensure a smoother start and consistent running of the program over time, consider the range of financial, legal, operational, and staffing issues and address those issues early. Leave room to be flexible and adapt to unexpected issues. Program characteristics that may facilitate implementation include:

• Clearly defined roles and responsibilities for specific staff members.
• Staff dedicated to HIV testing.
• Oversight by ED-based project manager.
• Consistent funding source.
• Easy access to a pool of dedicated staff (e.g., medical/nursing students, HIV counselors).
• Testing functions coordinated with typical staff duties (e.g., nurses draw specimens, lab runs all tests, physicians deliver test results).
• HIV testing made part of standard operations (e.g., all patients are offered an HIV test at triage and this is recorded in the medical record and executed by medical staff).
• ED providers oriented to the testing program and given guidelines and protocols on when testing is to be offered.

Characteristics that can impede implementation include:

• Limited space in the ED to accommodate additional staff.
• Limited staff capacity in laboratory to run tests.
• Turnover of supplemental staff dedicated to HIV testing.
• Real and perceived burden on providers to obtain informed consent.
• Real and perceived requirement to obtain informed consent.
• Providers' belief that HIV testing is an ancillary activity, secondary to treatment of chief complaints.
• Reliance on presence of counselor.
• Lack of method to follow up with patients who initially decline.
• Reliance on individual providers.
• Busy periods in ED and quick turnover of fast-track patients.
• Ongoing need for staff training.

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