Medical Technology

Institutional support is needed to boost HIV screening.

According to an examination of ED nurses, insufficient nursing education related to HIV is a major obstacle in the implementation of HIV screening initiatives in emergency departments (EDs). Nearly 43% of respondents stated that they received less or no HIV education as part their professional development and practice.

According to Candace Elam DNP, a family nursing practitioner at the Institute of Family Health, New York City, this lack of HIV education “often resulted into attitudes that did not support routine HIV screening in EDs,” she said Medscape Medical News. “But more than individual beliefs, what came out most clearly in the study was that the support of organizations for HIV screening in EDs was the one factor that could determine whether an emergency nurse performs HIV screening,” she said. This means integrating routine HIV screening into ED workflows and supplying resources to facilitate screening and testing efforts.

In 2006, the Centers for Disease Control and Prevention (CDC) released guidance which recommended routine HIV screening in all healthcare settings including urgent care as well as EDs. Elam was student at the Rutgers University School of Nursing student, conducted the study while working as an ED nurse. She discovered that the department had a policy in support of routine HIV screening however, it wasn’t uniform across nurses across the country. Elam conducted a national survey to discover what HIV screening differs across the country. Participants were contacted via email outreach and Facebook.

In the 30-45-minute survey, respondents reported:

  • Demographic information

  • The CDC HIV screening recommendations

  • Workplace HIV screening policy

  • Self-reported HIV screening results

  • HIV screening beliefs and attitudes

The survey was completed by 171 people from 43 states. In total, 371 people completed the survey. 76.9% of the 251 respondents who asked if their EDs regularly performed HIV screening replied positively. Overall, 28.5% of respondents believed that HIV screening was “not crucial” or “not at all important.” Nearly half (47.6 percent) of respondents said they never offered HIV tests for all patients eligible regardless of risk factors. Only 14.3 percent reported that they provide testing on a daily basis. Only 25 percent of participants reported receiving “adequate” or a “lot” of nursing education on HIV-related nursing. 42.9% reported receiving “little” or no education.

“For the most part, those of us who work in hospitals, all of the information we receive about HIV was done in school,” Elam said. “So when you attended school in the early 2000s or the 1990s, you won’t know much else.” Elam stated that she is informed on HIV research issues since it is an area of interest, but the hospital she worked at did not contribute much to her knowledge.

Elam also found that there were numerous obstacles to screening in practice, including a lack of a dedicated HIV educator or tester, not knowing where to refer patients who have positive HIV tests, and insufficient time to address positive HIV results in ED practice.

Elam explained that many of these variables are out of the control of nurses and can result in not being able to serve patients who would receive care. Lisa Leimer, RN, an RN at Primary Health Care in Des Moines, Iowa, works with patients who have been diagnosed with HIV, but said that a lot of her patients could have been identified earlier. “Once we get someone to look over medical records and notice that they’ve been in and out of the hospital,” she said. She said that there have been many encounters.

Prioritizing HIV screening in all healthcare settings, and including HIV education for all medical professionals — not just nurses -could aid in the ongoing fight against HIV. “So much has changed in the world of HIV,” she said. “We are trying to end the spread of the disease. It could be possible if those living with HIV were identified, diagnosed and treated.”

Elam and Leimer have reported no relevant financial connections.

Association of Nurses in AIDS Care 2021. Presented November 11, 2021.

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