Hospital-based routine HIV testing in high-income countries: a systematic literature review
File(s)
Accepted version
Author(s)
Elgalib, A
Fidler, S
Sabapathy, K
Type
Journal Article
Abstract
Objectives:
To produce a summary of the published evidence of the barriers and facilitators for hospital‐based routine HIV testing in high‐income countries.
Methods:
Electronic databases were searched for studies, which described the offer of HIV testing to adults attending emergency departments (EDs) and acute medical units (AMUs) in the UK and US, published between 2006 and 2015. Other high‐income countries were not included, as their guidelines do not recommend routine testing for HIV. The main outcomes of interest were HIV testing uptake, HIV testing coverage, factors facilitating HIV screening and barriers to HIV testing. Fourteen studies met the pre‐defined inclusion criteria and critically appraised using mixed methods appraisal tool (MMAT).
Results:
HIV testing coverage ranged from 9.7% to 38.3% and 18.7% to 26% while uptake levels were high (70.1–84% and 53–75.4%) in the UK and US, respectively. Operational barriers such as lack of time, the need for training and concerns about giving results and follow‐up of HIV positive results, were reported. Patient‐specific factors including female sex, old age and low risk perception correlated with refusal of HIV testing. Factors that facilitated the offer of HIV testing were venous sampling (vs. point‐of‐care tests), commitment of medical staff to HIV testing policy and support from local HIV specialist providers.
Conclusions:
There are several barriers to routine HIV testing in EDs and AMUs. Many of these stem from staff fears about offering HIV testing due to the perceived lack of knowledge about HIV. Our systematic review highlights areas which can be targeted to increase coverage of routine HIV testing.
To produce a summary of the published evidence of the barriers and facilitators for hospital‐based routine HIV testing in high‐income countries.
Methods:
Electronic databases were searched for studies, which described the offer of HIV testing to adults attending emergency departments (EDs) and acute medical units (AMUs) in the UK and US, published between 2006 and 2015. Other high‐income countries were not included, as their guidelines do not recommend routine testing for HIV. The main outcomes of interest were HIV testing uptake, HIV testing coverage, factors facilitating HIV screening and barriers to HIV testing. Fourteen studies met the pre‐defined inclusion criteria and critically appraised using mixed methods appraisal tool (MMAT).
Results:
HIV testing coverage ranged from 9.7% to 38.3% and 18.7% to 26% while uptake levels were high (70.1–84% and 53–75.4%) in the UK and US, respectively. Operational barriers such as lack of time, the need for training and concerns about giving results and follow‐up of HIV positive results, were reported. Patient‐specific factors including female sex, old age and low risk perception correlated with refusal of HIV testing. Factors that facilitated the offer of HIV testing were venous sampling (vs. point‐of‐care tests), commitment of medical staff to HIV testing policy and support from local HIV specialist providers.
Conclusions:
There are several barriers to routine HIV testing in EDs and AMUs. Many of these stem from staff fears about offering HIV testing due to the perceived lack of knowledge about HIV. Our systematic review highlights areas which can be targeted to increase coverage of routine HIV testing.
Date Issued
2017-11-23
Date Acceptance
2017-10-04
Citation
HIV Medicine, 2017, 19 (3), pp.195-205
ISSN
1464-2662
Publisher
Wiley
Start Page
195
End Page
205
Journal / Book Title
HIV Medicine
Volume
19
Issue
3
Copyright Statement
© 2017 British HIV Association. This is the peer reviewed version of the article, which has been published in final form at https://dx.doi.org/10.1111/hiv.12568. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Sponsor
National Institutes of Health
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000425633800006&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
PO15001410 (UMIAI068619)
Subjects
Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
high-income
HIV
hospital
routine
testing
HEALTH-CARE SETTINGS
EMERGENCY-DEPARTMENT
MISSED OPPORTUNITIES
STAFF ATTITUDES
PERSONS AWARE
UNITED-STATES
MEDICAL-CARE
ACCEPTANCE
PATIENT
COST
Publication Status
Published