Use of tablet-based kiosks in the emergency department to guide patient HIV self-testing with a point-of-care oral fluid test

Abstract

Despite successes in efforts to integrate HIV testing into routine care in emergency departments, challenges remain. Kiosk-facilitated, directed HIV self-testing offers one novel approach to address logistical challenges. Emergency department patients, 18–64 years, were recruited to evaluate use of tablet-based-kiosks to guide patients to conduct their own point-of-care HIV tests followed by standard-of-care HIV tests by healthcare workers. Both tests were OraQuick Advance tests. Of 955 patients approached, 473 (49.5%) consented; 467 completed the test, and 100% had concordant results with healthcare workers. Median age was 41 years, 59.6% were female, 74.8% were African-American, and 19.6% were White. In all, 99.8% of patients believed the self-test was “definitely” or “probably” correct; 91.7% of patients “trusted their results very much”; 99.8% reported “overall” self-testing was “easy or somewhat easy” to perform. Further, 96.9% indicated they would “probably” or “definitely” test themselves at home were the HIV test available for purchase; 25.9% preferred self-testing versus 34.4% who preferred healthcare professional testing (p > 0.05). Tablet-based kiosk testing proved to be highly feasible, acceptable, and an accurate method of conducting rapid HIV self-testing in this study; however, rates of engagement were moderate. More research will be required to ascertain barriers to increased engagement for self-testing.

Keywords

Human immunodeficiency virus screening HIV AIDS testing oral fluid OraQuick Advance self-testing tablet-based-kiosks point of care test rapid test acceptability emergency department

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References

Centers for Disease Control and Prevention. HIV Surveillance Report: Estimated HIV incidence in the United States, 2007-2010. HIV Surv Suppl Rep 2012; 17: 1–26.

Hall

Song

Rhodes

. Estimation of HIV incidence in the United States. JAMA 2008; 300: 520–529.

Centers for Disease Control and Prevention. Revised recommendations for HIV counseling, testing, and referral. MMWR 2001; 50: 1–62.

Branson

Handsfield

Lampe

. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006; 55: 1–17.

Ehrenkranz

Ahn

lay

. Availability of rapid human immunodeficiency virus testing in academic emergency departments. Acad Emerg Med 2008; 15: 144–150.

Kelen

Rothman

. Emergency department-based HIV testing: too little, but not too late. Ann Emerg Med 2009; 54: 65–71.

White

Scribner

Schulden

. Results of a rapid HIV screening and diagnostic testing program in an urban emergency department. Ann Emerg Med 2009; 54: 56–64.

Gaydos

Hsieh

Y-H

Harvey

. Will patients “Opt-In” to perform their own rapid HIV test in the emergency department? Ann Emerg Med 2011; 58: S74–S78.

Nour

Hsieh

Y-H

Jett‐Goheen

. Patients can accurately perform their own rapid HIV point-of-care test in the emergency department. Point Care J 2012; 11: 176–179.

10.

Haukoos

Hopkins

Bender

. Use of kiosks and patient understanding of opt-out and opt-in consent for routine rapid human immunodeficiency virus screening in the emergency department. Acad Emerg Med 2012; 19: 287–293.

11.

Hsieh

Y-H

Jung

Shahan

. Outcomes and cost analysis of three operational models for rapid HIV testing services in an academic inner-city emergency department. Ann Emerg Med 2011; 58: S133–S139.

12.

Haukoos

White

Lyons

. National Emergency Department HIV Testing Consortium. Operational methods of HIV testing in emergency departments: a systematic review. Ann Emerg Med 2011; 58: S96–S103.