Screening for undiagnosed human immunodeficiency virus infection in Spanish emergency departments: current attitudes, inclination, and perception of obstacles related to the implementation of measures to improve detection.

Objectives: To describe current attitudes toward screening for undiagnosed human immunodeficiency virus (HIV) infection in Spanish hospital emergency departments (EDs). To describe staff willingness to implement screening protocols and the obstacles they foresee.

Material And Methods: Structured survey of all chiefs of hospital EDs seeing adults 24 hours per day within the Spanish national health system. The ED chiefs were asked about their departments' routine HIV screening practices, their willingness to screen, and the perceived obstacles to implementing measures to improve screening. Findings were compared according to hospital size (large hospitals, 500 beds; small-medium hospitals, 500 beds), ED caseload (high, 200 patients/d; low, 200 patients/d), and Spanish autonomous community.

Results: The chiefs of 250 of the 282 EDs (88.7%) responded. Fifty-nine (23.6%) were in large hospitals, and 114 (45.6%) had high caseloads. HIV serology for suspected HIV infection is never or hardly ever ordered in 65.2% of the EDs. If serology is ordered, 17.6% request rapid processing. Nearly half (47.8%) thought that EDs should not screen for undiagnosed HIV infection; in Asturias, Castile and Leon, Extremadura, and Navarre over 75% of respondents expressed that opinion. Three of the 9 proposed measures to improve HIV screening in EDs were considered quite difficult or very difficult to implement. One measure that was considered problematic was nurse identification of highrisk patients during triage (for 61% of respondents overall and > 75% in the communities of Madrid and Valencia, Murcia, Aragon, and Navarre). A second foreseen difficulty was gaining hospital directors' and administrators' acceptance of universal HIV screening (for 59% overall and > 75% in Madrid, Aragon, and Navarre). The third was gaining emergency physicians' acceptance of screening (57% overall and > 75% in Madrid, Navarre, Basque Country, and Extremadura). In the remaining autonomous communities, fewer than 35% of the ED chiefs foresaw difficulties. ED chiefs in large hospitals and with high caseloads accepted HIV screening more readily, both in terms of current practice and the implementation of improved screening protocols.

Conclusion: There is considerable room for improvement in hospital ED screening for undiagnosed HIV infection. Some measures aimed at better screening would be more acceptable to the surveyed EDs, but there are marked differences in attitudes between autonomous communities.