Emergency Physician Attitudes, Barriers, and Facilitators to HIV and Syphilis Testing

The emergency department (ED) provides an important opportunity to identify new HIV and syphilis cases and initiate and/or link to treatment. Rapid testing combined with patient navigation may improve emergency physician attitudes and adoption of targeted HIV and syphilis testing.

We implemented rapid testing with patient navigation at two clinical sites, one site in August 2025 and a second site planned for January 2026. To understand physician attitudes, knowledge, barriers and facilitators to ED-based testing, we administered surveys to ED attendings and residents in November 2024 prior to implementation and in December 2025 following education and implementation at one clinical site. A sample of ED attending and resident physicians at both sites completed surveys anonymously, and data were analyzed in aggregate using Fisher’s Exact Test for difference in responses to the two surveys.

Fifty-nine ED physicians completed the first survey and 49 completed the second survey, including 26 (53.1%) resident and 23 (46.9%) attending physicians. Survey response rate was 44.1% for resident and 24.2% for attending physicians. Perceptions that HIV screening is within the scope of emergency medicine increased from 74.6% to 93.9% (p=0.009). There was no change in physician confidence in identifying patients who would benefit from HIV and syphilis testing (45.8% vs 60.4%, p=0.12 and 59.3% vs 67.3%, p=0.32), respectively. Though persistent, there was a decrease in perceived barriers to HIV testing including time to counsel patients (HIV 76.3% to 51%, p=0.008), comfort with next step of care if results are positive (61% to 34.7%, p=0.007), availability of linkage to outpatient treatment after discharge (71.2% to 51%, p=0.05), and time to test result receipt (62.7% to 30.6%, p=0.001). Respondents identified electronic health record clinical decision support, availability of pharmacist consultation, patient navigator to link to outpatient care, and staff education as facilitators to improve testing.

ED physician positive attitudes increased with partial implementation of rapid testing combined with patient navigation to facilitate linkage to care after ED visits. While there was no change in physician confidence, there was a decrease in barriers to HIV testing. Further interventions are needed to support patient privacy, staff education and linkage to care.