Understanding providers' offering and patients' acceptance of HIV screening in emergency departments: a multilevel analysis. ANRS 95008, Paris, France

Kayigan Wilson d'Almeida, Dominique Pateron, Gérald Kierzek, Bertrand Renaud, Caroline Semaille, Pierre de Truchis, François Simon, Judith Leblanc, France Lert, Stéphane Le Vu, Anne-Claude Crémieux, Kayigan Wilson d'Almeida, Dominique Pateron, Gérald Kierzek, Bertrand Renaud, Caroline Semaille, Pierre de Truchis, François Simon, Judith Leblanc, France Lert, Stéphane Le Vu, Anne-Claude Crémieux

Abstract

Objective: We assessed the EDs' characteristics associated with the offer and acceptance rates of a nontargeted HIV rapid-test screening in 29 Emergency Departments (EDs) in the metropolitan Paris region (11.7 million inhabitants), where half of France's new HIV cases are diagnosed annually.

Methods: EDs nurses offered testing to all patients 18-64-year-old, able to provide consent, either with or without supplemental staff (hybrid staff model or indigenous staff model). The EDS' characteristics collected included structural characteristics (location, type, size), daily workload (patients' number and severity, length of stay in hours), staff's participation (training, support to the intervention, leadership), type of week day (weekends vs weekdays) and time (in days). Associations between these variables and the staff model, the offer and acceptance rates were studied using multilevel modeling.

Results: Indigenous staff model was more frequent in EDs with a lower daily patient flow and a higher staff support score to the intervention. In indigenous-model EDs, the offer rate was associated with the patient flow (OR = 0.838, 95% CI = 0.773-0.908), was lower during weekends (OR = 0.623, 95% CI = 0.581-0.667) and decreased over time (OR = 0.978, 95% CI = 0.975-0.981). Similar results were found in hybrid-model EDs. Acceptance was poorly associated with EDs characteristics in indigenous-model EDs while in hybrid-model EDs it was lower during weekends (OR = 0.713, 95% CI = 0.623-0.816) and increased after the first positive test (OR = 1.526, 95% CI = 1.142-2.038). The EDs' characteristics explained respectively 38.5% and 15% of the total variance in the offer rate across indigenous model-EDs and hybrid model-EDs vs 12% and 1% for the acceptance rate.

Conclusion: Our findings suggest the need for taking into account EDs' characteristics while considering the implementation of an ED-based HIV screening program. Strategies allowing the optimization of human resources' utilization such as HIV targeted screening in the EDs might be privileged.

Conflict of interest statement

Competing Interests: Dr Anne-Claude Crémieux reported receiving grants from Janssen-Cilag, Novartis, AstraZeneca, Aventis and Haeraus for consultancies, workshops and travel to meetings and accommodations. Dr Pierre de Truchis reported receiving grants from Abbott, BMS, Gilead, MSD, Tibotec Janssen and ViiV Healthcare for workshops and travel to meetings and accommodations. Dr François Simon reported receiving grants from the French Health Products Safety Agency (Afssaps) for the evaluation of Orasure RTD. Rapid tests were provided free of charge by Orasure Technologies Inc., Bethlehem, Pennsylvania. There are no patents, products in development or marketed products to declare. The other authors have no disclosures to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1. Patient flow diagram.
Figure 1. Patient flow diagram.
*Exclusion criteria were the following: age 65 years (51%), serious/unstable illness (15%), inability to provide consent (31%), known HIV seropositivity (2%).
Figure 2. EDs’ characteristics associated with the…
Figure 2. EDs’ characteristics associated with the offering and acceptance of HIV-RT in the EDs (multivariate analysisa).
aTeam support, proportion of seriously ill patients, length of stay, time and number of beds in the hospital are continuous variables. All the others are categorical variables *P<.05.

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