Background
At our emergency department (ED), 1% of all patients seen are tested for HIV. This study explored patient- and physician-led barriers and acceptability of rapid HIV testing.
Methods
Between October 2014 and May 2015, 100 patient-physician pairs were interviewed in the ED of Lausanne University Hospital, Lausanne, Switzerland. Patients completed a questionnaire on HIV risk factors and were offered free rapid HIV testing (INSTITM). For every patient included, the treating physician was asked if HIV testing had been indicated according to the national testing recommendations, mentioned, or offered during the consultation.
Results: Of 100 patients, 30 had indications for HIV testing through risk factors or a suggestive presenting complaint. Although 17 patients wished to be tested during their ED consultation, none raised the subject with their physician. Fifty patients accepted rapid testing; no test was reactive. Of 50 patients declining testing, 82% considered themselves not at risk or had recently tested negative and 16% wished to focus on their presenting complaint (PC). Twenty physicians identified patients with testing indications and six offered testing. The main reason for not mentioning or offering testing was the wish to focus on the PC.
Conclusion: Patients and physicians at our ED share the barrier of wishing to focus on the PC. Rapid HIV testing offered in parallel to the patient-physician consultation increased the testing rate from 6% (offered by physicians) to 50%. Introducing this service would enable testing of patients not offered tested by their physicians and optimise early HIV diagnoses.