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. 2020 Jul 22;21(1):1105.
doi: 10.4102/sajhivmed.v21i1.1105. eCollection 2020.

Patient acceptance of HIV testing services in rural emergency departments in South Africa

Aditi Rao  1 , Caitlin Kennedy  1 , Pamela Mda  2 , Thomas C Quinn  3   4 , David Stead  5   6 , Bhakti Hansoti  1   3
Affiliations

Patient acceptance of HIV testing services in rural emergency departments in South Africa

Aditi Rao et al. South Afr J HIV Med. .

Abstract

Background: South Africa faces the highest burden of HIV infection globally. The National Strategic Plan on HIV recommends provider-initiated HIV counselling and testing (HCT) in all healthcare facilities. However, HIV continues to overwhelm the healthcare system. Emergency department (ED)-based HCT could address unmet testing needs.

Objectives: This study examines the reasons for accepting or declining HCT in South African EDs to inform the development of HCT implementation strategies.

Method: We conducted a prospective observational study in two rural EDs, from June to September 2017. Patients presenting to the ED were systematically approached and offered a point-of-care test in accordance with national guidelines. Patients demographics, presenting compaint, medical history and reasons for accepting/declining testing, were recorded. A pooled analysis is presented.

Results: Across sites, 2074 adult, non-critical patients in the ED were approached; 1880 were enrolled in the study. Of those enrolled, 19.7% had a previously known positive diagnosis, and 80.3% were unaware of their HIV status. Of those unaware, 90% patients accepted and 10% declined testing. The primary reasons for declining testing were 'does not want to know status' (37.6%), 'in too much pain' (34%) and 'does not believe they are at risk' (19.9%).

Conclusions: Despite national guidelines, a high proportion of individuals remain undiagnosed, of which a majority are young men. Our study demonstrated high patient acceptance of ED-based HCT. There is a need for investment and innovation regarding effective pain management and confidential service delivery to address patient barriers. Findings support a routine, non-targeted HCT strategy in EDs.

Keywords: HIV counselling and testing; South Africa; emergency department; implementation research; linkage to care; patient acceptance.

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Conflict of interest statement

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Figures

FIGURE 1
FIGURE 1
Flow diagram demonstrating study enrolment and outcomes.
See this image and copyright information in PMC

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