Streamlining HIV Testing in the Emergency Department – Leveraging Kiosks to Provide True Universal Screening

Background: Emergency Department (ED) HIV screening programs remain limited by the unsustainable cost of exogenous staff and penetration rates <10%.  Kiosk systems have increased registration efficiency in various clinical settings and have shown promising results for advancing public health initiatives.

Objectives: To evaluate the usability of kiosks within the existing HIV testing program and to assess patients’ perceived acceptability of employing kiosk-based screening in the ED.

Methods: Patients approached by the current ED HIV testing program were asked to complete both the registration module (intended to integrate into the ED’s pending kiosk registration system) and risk assessment module on a touch-screen tablet.  Participants provided feedback upon program completion.  All comments, questions, and errors were documented.  Quantitative (chi-squared test or t-test) and qualitative data analysis was performed.

Results: Subjects (n=62) were 60% female, 69% black, age 37.8±11.4 years; 52% had a high school degree or less, and 50% reported no prior kiosk experience.  Mean time spent on the registration and risk assessment modules was 2:35±1:24 and 5:09±1:58 minutes respectively.  The leading technical issue was login – 84% of patients required assistance.  Removal of the login screen reduced times to 1:05±0:36 and 4:10±1:38 minutes.  Education level inversely correlated with length of use(p<0.05).  95% of subjects reported length of use as “just right” and over 75% patients found the software easy to use, answered questions without help, and preferred screening on the kiosk to in-person interviews.  Favorite aspects of the program included: ease of use(52%); privacy(48%); and speed(30%).  66% of patients reported there was nothing they disliked or would change. 

Conclusions: ED patient response to the kiosk system was overwhelmingly favorable.  Subjects easily, and quickly, navigated the program, with the exception of login which can be eliminated via ID bracelet scanners.

Implications for Programs, Policy, and Research: Findings indicate significant potential for kiosk-based public health programs to provide true universal screening in the ED.