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HIV Testing in Emergency Departments: A Practical Guide
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Training Staff

What training does staff require?

Staff will need to be trained on several levels.

  • All staff in the ED will need to be informed of the basics of HIV, and why expanded screening has clinical and public health value, as well as how HIV testing can be accomplished in the ED.   
  • Staff responsible for HIV testing in the ED will need additional training in ED operations and culture (if they are external staff) in addition to HIV testing operations. 
  • Clinical staff will require additional training on recognizing the clinical signs and symptoms of HIV and AIDS, including acute HIV infection. These may be refresher courses for some. 
  • Testing staff will need to demonstrate proficiency in administering tests and interpreting results.

States may have specific training requirements that are determined by statute or regulation.  Providers should contact their state health department to ascertain which requirements apply to them and other staff performing testing in an ED. 

This section provides general considerations for training staff.  The resources we provide can inform and be adopted for training in your facility. Local and state health departments and AIDS Education and Training Centers (PDF) (AETCs) are excellent resources for training on HIV generally and HIV testing specifically.


 

For Staff Affected by HIV Testing in the ED

The patient care team (emergency department and infectious disease) should be educated about HIV testing and the purpose of HIV testing in your ED. Training of staff should include:

  • Rationale for increased HIV testing in acute care settings, including the advantages and disadvantages of risk-based testing in identifying HIV infection
  • Local, regional, and national HIV/AIDS statistics
  • State and local statues regarding HIV testing, including reporting and Partner Counseling and Referral Services (PCRS)
  • CDC recommendations for HIV testing in health care settings
  • Benefits of early HIV diagnosis
  • Strategies to ensure confidentiality
  • Interpretation methods for test results
  • Local referrals and follow-up care for HIV-infected patients

In addition, staff will be informed about:

  • What patients are eligible for HIV testing
  • How patients will be identified or approached
  • Conducting the test
  • Interpreting results
  • Consent process and local testing laws
  • Confidentiality and recordkeeping
  • Privacy
  • Delivering test results
  • Providing patient follow-up
  • Quality controls/Quality assurance processes
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For Staff Responsible for HIV Testing in the ED

In addition to the general orientation to HIV and HIV testing operations described above, staff who will be conducting tests will need training in test administration. Laboratory, medical and/or nursing staff, health department, or other hospital staff educators will train these staff in specimen draws, procedures for sending them to the lab, as well as documentation. If rapid tests are used, they will train personnel to perform rapid HIV tests at point of care.  

A comprehensive training session for rapid HIV testing will enable participants to:

  • Review the rapid test package insert along with the facility's standard operating procedure
  • View the rapid HIV testing video provided by the manufacturer (when relevant)
  • Observe a demonstration of how to set up the rapid HIV test
  • Perform a panel of five known specimens and obtain 100 percent accuracy
  • Take a competency test on the rapid HIV test with 100 percent accuracy or counseling documented for incorrect answers

The following points should be emphasized throughout training, and all staff should be able to comfortably:

  • Handle requests for rapid HIV testing
  • Verify that appropriate positive and negative controls have been performed on the lot number in use and match expected results before setting up a patient's specimen
  • Read the rapid HIV test 15-45 minutes after setup (the specific time according to the type of rapid test). A timer can be clipped onto one's uniform to ensure that the test is read within the time limit.
  • Report results as soon as possible
  • Document all rapid HIV test results and inform the patient's health care provider according to protocol
  • Refer all specimens that test preliminary reactive to the appropriate laboratory for confirmatory testing
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Special Considerations

The busy emergency department does not offer many opportunities for formal in-service training. Careful thought is needed to present content. Key considerations include:

  • Making training and content available at times convenient for ED staff and providers
  • Deciding how the training program will be delivered, tailoring it to the needs of the staff who will be conducting the test. For example, the methods used to train nurses may be different from the methods used to train counselors.
  • Increasing motivation for learning by offereing CME (continuing medical education) and nursing CE (continuing education) contact hours.
  • Helping your hospital provide periodic opportunities for staff conducting rapid HIV tests and HIV care providers to "cross-train" in order to facilitate connections to follow-up care. 

Click here for more information on training design and implementation.

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Resources

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This guide was made possible through a cooperative agreement between the Centers for Disease Control and
Prevention (CDC) and the Association for Prevention Teaching and Research (APTR), award number TS-0990;
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