TY - JOUR
T1 - Patient acceptance of HIV testing services in rural emergency departments in South Africa
AU - Rao, Aditi
AU - Kennedy, Caitlin
AU - Mda, Pamela
AU - Quinn, Thomas C.
AU - Stead, David
AU - Hansoti, Bhakti
N1 - Funding Information:
This research was supported by the South African Medical Research Council, the Division of Intramural Research, the National Institute of Allergy and Infectious Diseases, National Institutes of Health, and the Johns Hopkins Center for Global Health.
Publisher Copyright:
© 2020 AOSIS (pty) Ltd. All rights reserved.
PY - 2020/7
Y1 - 2020/7
N2 - Background: South Africa faces the highest burden of HIV infection globally. The National Strategic Plan on HIV recommends provider-initiated HIV counselling and testing (HCT) in all healthcare facilities. However, HIV continues to overwhelm the healthcare system. Emergency department (ED)-based HCT could address unmet testing needs. Objectives: This study examines the reasons for accepting or declining HCT in South African EDs to inform the development of HCT implementation strategies. Method: We conducted a prospective observational study in two rural EDs, from June to September 2017. Patients presenting to the ED were systematically approached and offered a point-of-care test in accordance with national guidelines. Patients demographics, presenting compaint, medical history and reasons for accepting/declining testing, were recorded. A pooled analysis is presented. Results: Across sites, 2074 adult, non-critical patients in the ED were approached; 1880 were enrolled in the study. Of those enrolled, 19.7% had a previously known positive diagnosis, and 80.3% were unaware of their HIV status. Of those unaware, 90% patients accepted and 10% declined testing. The primary reasons for declining testing were 'does not want to know status' (37.6%), 'in too much pain' (34%) and 'does not believe they are at risk' (19.9%). Conclusions: Despite national guidelines, a high proportion of individuals remain undiagnosed, of which a majority are young men. Our study demonstrated high patient acceptance of ED-based HCT. There is a need for investment and innovation regarding effective pain management and confidential service delivery to address patient barriers. Findings support a routine, non-targeted HCT strategy in EDs.
AB - Background: South Africa faces the highest burden of HIV infection globally. The National Strategic Plan on HIV recommends provider-initiated HIV counselling and testing (HCT) in all healthcare facilities. However, HIV continues to overwhelm the healthcare system. Emergency department (ED)-based HCT could address unmet testing needs. Objectives: This study examines the reasons for accepting or declining HCT in South African EDs to inform the development of HCT implementation strategies. Method: We conducted a prospective observational study in two rural EDs, from June to September 2017. Patients presenting to the ED were systematically approached and offered a point-of-care test in accordance with national guidelines. Patients demographics, presenting compaint, medical history and reasons for accepting/declining testing, were recorded. A pooled analysis is presented. Results: Across sites, 2074 adult, non-critical patients in the ED were approached; 1880 were enrolled in the study. Of those enrolled, 19.7% had a previously known positive diagnosis, and 80.3% were unaware of their HIV status. Of those unaware, 90% patients accepted and 10% declined testing. The primary reasons for declining testing were 'does not want to know status' (37.6%), 'in too much pain' (34%) and 'does not believe they are at risk' (19.9%). Conclusions: Despite national guidelines, a high proportion of individuals remain undiagnosed, of which a majority are young men. Our study demonstrated high patient acceptance of ED-based HCT. There is a need for investment and innovation regarding effective pain management and confidential service delivery to address patient barriers. Findings support a routine, non-targeted HCT strategy in EDs.
KW - Emergency department
KW - HIV counselling and testing
KW - Implementation research
KW - Linkage to care
KW - Patient acceptance
KW - South Africa
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U2 - 10.4102/SAJHIVMED.V21I1.1105
DO - 10.4102/SAJHIVMED.V21I1.1105
M3 - Article
AN - SCOPUS:85090469060
SN - 1608-9693
VL - 21
JO - Southern African Journal of HIV Medicine
JF - Southern African Journal of HIV Medicine
IS - 1
M1 - a1105
ER -