Objectives Increased test uptake for HIV and viral hepatitis is fast becoming a health priority at both national and global levels. Late diagnosis of these infections remains a critical public health concern in the UK. Recommendations have been issued to expand blood-borne virus (BBV) testing in alternative settings. Emergency departments (EDs) offer a potentially important point of testing. This paper presents findings from a qualitative study which aimed to explore the acceptability and feasibility of a routine opt-out combined BBV testing intervention implemented at an inner London ED. Methods We conducted 22 semistructured interviews with patients and service providers in the ED over a 4-month period during the intervention pilot. A grounded analytical approach was employed to conduct thematic analysis of qualitative study data. Results Core interrelating thematic areas, identified and analytically developed in relation to test intervention implementation and experience, included the following: the remaking of routine test procedure; notions of responsibility in relation to status knowledge and test engagement; the opportunity and constraints of the ED as a site for testing; and the renegotiation of testing cultures within and beyond the clinic space. Conclusion Study findings demonstrate how relational and spatial dynamics specific to the ED setting shape test meaning and engagement. We found acceptability of the test practice was articulated through narratives of situated responsibility, with the value of the test offset by perceptions of health need and justification of the test expense. Participant accounts indicate that the nontargeted approach of the test affords a productive disruption to a € at-risk' identities, yet they also reveal limits to the test intervention's a € normalising' effect. Evaluation of the intervention must attend to the situated dynamics of the test practice if opportunities of an opt-out BBV test procedure are to be fully realised. Findings also highlight the critical need to further evaluate post-test intervention practices and experiences.
Bibliographical noteFunding Information:
Funding The study was undertaken with funding from the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England and in collaboration with London School of Hygiene and Tropical Medicine. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or Public Health England.
Competing interests CO has received research grants, lecture fees, travel grants and honoraria towards advisory boards from MSD, Gilead, Viiv and Janssen. Towards this work, CO received funding for the testing project by a Gilead Fellowship grant. AR receives nonrestricted grant funding from Gilead. LC, PG, SM and TR declare no conflicts of interest in relation to this work and its submission. The paper has not been previously published and neither is it being considered for publication elsewhere.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
- qualitative research
- viral hepatitis