Original Research

Implementing emergency department-based HIV testing in a low-resource setting: The value of a structured feasibility assessment tool

Madeleine Whalen, Pamela Mda, Andy Parrish, Thomas C. Quinn, Richard Rothman, David Stead, Bhakti Hansoti
Southern African Journal of HIV Medicine | Vol 19, No 1 | a793 | DOI: https://doi.org/10.4102/sajhivmed.v19i1.793 | © 2018 Madeleine Whalen, Pamela Mda, Andy Parrish, Thomas C. Quinn, Richard Rothman, David Stead, Bhakti Hansoti | This work is licensed under CC Attribution 4.0
Submitted: 28 July 2017 | Published: 16 July 2018

About the author(s)

Madeleine Whalen, Johns Hopkins Hospital, United States
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, United 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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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.


Keywords

HIV; emergency department

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