Original Research Contribution

Characteristics of U.S. Emergency Departments That Offer Routine Human Immunodeficiency Virus Screening

  1. Laura J. Berg MD,
  2. M. Kit Delgado MD, MS,
  3. Adit A. Ginde MD, MPH,
  4. Juan Carlos Montoy MD, PhD,
  5. Eran Bendavid MD, MS,
  6. Carlos A. Camargo Jr. MD, DrPH

Article first published online: 31 JUL 2012

DOI: 10.1111/j.1553-2712.2012.01401.x

Issue

Academic Emergency Medicine

Academic Emergency Medicine

Volume 19, Issue 8, pages 894–900, August 2012

Additional Information

How to Cite

Berg, L. J., Delgado, M. K., Ginde, A. A., Montoy, J. C., Bendavid, E. and Camargo, C. A. (2012), Characteristics of U.S. Emergency Departments That Offer Routine Human Immunodeficiency Virus Screening. Academic Emergency Medicine, 19: 894–900. doi: 10.1111/j.1553-2712.2012.01401.x

Author Information

  1. From the Stanford–Kaiser Emergency Medicine Residency (LJB), Stanford, CA; the Center for Primary Care and Outcomes Research (MKD, EB) and the Division of Emergency Medicine (MKD) and the Division of General Medical Disciplines (EB), Stanford University School of Medicine, Stanford, CA; the Department of Emergency Medicine (AAG), University of Colorado School of Medicine, Aurora, CO; the University of California San Francisco (UCSF) - San Francisco General Hospital (SFGH) Emergency Medicine Residency (JCM); and the Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School (CAC), Boston, MA.

*Address for correspondence and reprints: M. Kit Delgado, MD; e-mail: kdelgado@stanford.edu.

  1. Presented at the American College of Emergency Physicians’ research forum, Las Vegas, NV, November 2010.

  2. Dr. Delgado was supported by the Agency for Health Care Research and Quality training grant T32HS00028 to the Center for Primary Care and Outcomes Research, Stanford University. Dr. Bendavid was supported in part by an NIH Career Development award.

  3. The authors have no other disclosures or conflictions of interest to report.

  4. Supervising Editor: Lee Wilbur, MD.

  5. A related commentary appears on page 975.

Publication History

  1. Issue published online: 20 AUG 2012
  2. Article first published online: 31 JUL 2012
  3. Received November 29, 2011; revision received March 10, 2012; accepted March 24, 2012.

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ACADEMIC EMERGENCY MEDICINE 2012; 19:894–900 © 2012 by the Society for Academic Emergency Medicine

Abstract

Objectives:  The association between emergency department (ED) characteristics, ED director’s perceptions of preventive services, and the availability of human immunodeficiency virus (HIV) screening are unknown. The authors hypothesized that, after adjusting for ED operational and demographic characteristics, teaching hospital status would be associated with increased availability, and ED crowding and ED director agreement with barriers to screening would be associated with decreased availability.

Methods:  This was a secondary, cross-sectional analysis on previously collected data from 2008 to 2009 regarding availability of ED preventive services. Data were obtained from a random sample of 277 EDs in which ED directors provided information on ED characteristics and availability of HIV screening and rated five barriers to providing preventive services. The association between the availability of HIV screening and teaching hospital and crowding status, ED volume, urban–rural location, ownership, geographic region, patient demographics, state HIV testing consent laws, and ED director opinions on barriers to providing preventive services were determined in univariate analyses and a multivariate logistic regression model.

Results:  Nineteen percent of the sampled EDs offer HIV screening. Teaching hospitals offer HIV screening more frequently than nonteaching hospitals (38% vs. 18%; p = 0.03), but after adjusting for other characteristics in a multivariate model, this association was not significant (relative risk ratio [RR] = 2.07, 95% confidence interval [CI] = 0.91 to 3.59). ED crowding also was not significantly associated with screening availability (RR = 0.66, 95% CI = 0.34 to 1.21). However, public ownership (RR = 2.13, 95% CI = 1.28 to 3.14), 24-hour social work (RR = 1.87, 95% CI = 1.02 to 2.99), uninsured population ≥35% (RR = 2.48, 95% CI = 1.39 to 3.69), increased local nonwhite minority population percentage (RR = 1.14 per 10%, 95% CI = 1.02 to 1.26), and state laws allowing opt-out consent for testing (RR = 1.76, 95% CI = 1.01 to 2.74) were associated with increased availability of screening in multivariable analysis. EDs whose directors were concerned about added costs were associated with decreased availability of screening (RR = 0.45, 95% CI = 0.23 to 0.85).

Conclusions:  After adjusting for other ED operational and demographic characteristics, ED crowding and teaching hospital affiliation were not independently associated with the availability of HIV screening. EDs whose directors were concerned about the cost of preventive services were less likely to provide routine HIV screening. Addressing ED director’s concerns about the added costs of ED preventive services, increasing social work availability, and implementing testing laws consistent with Centers for Disease Control and Prevention (CDC) recommendations may facilitate increased adoption of ED HIV screening.

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