Background
Many barriers to HIV testing in the emergency department (ED) have been described. At our
centre, 1% of all patients seen are tested for HIV against a local HIV seroprevalence of 0.4%.
This study explored patient- and physician-led barriers and acceptability of rapid HIV testing.
Methods
Between October 2014 and May 2015, 100 patient-physician pairs were interviewed in the
ED of Lausanne University Hospital, Lausanne, Switzerland. Prior to the study, ED
physicians attended training seminars on the national HIV testing recommendations and the
practice of testing. Patients completed a questionnaire on HIV risk factors and were offered
free rapid HIV testing (INSTI􀂌). For every patient included, the treating physician was asked
if HIV testing had been indicated according to the national testing recommendations,
mentioned, or offered during the consultation.
Results: Of 100 patients, 30 had indications for HIV testing through having risk factors or a
suggestive presenting complaint. Seventeen patients wished to be tested during their ED
consultation but none raised the subject when not mentioned by the physician. Fifty patients
accepted rapid testing, regardless of risk profile; no test was reactive. Of 50 patients
declining testing, 82% considered themselves not at risk or had recently tested negative and
16% wished to focus on their presenting complaint. Twenty physicians identified patients with
testing indications and six offered testing. The main reason for not mentioning or offering
testing was the wish to focus on the presenting complaint.
Conclusion: Patients and physicians at our ED share the testing barrier of wishing to focus
on the presenting complaint. Rapid HIV testing offered in parallel to the patient-physician
consultation increased the testing rate from 6% to 50%. Introducing this service would enable
testing of patients with presentations clinically unrelated to HIV and optimise early (presymptomatic)
HIV diagnosis.