Patient Perspectives on the Experience of Being Newly Diagnosed with HIV in the Emergency Department/Urgent Care Clinic of a Public Hospital

We sought to understand patient perceptions of the emergency department/urgent care (ED/UC) HIV diagnosis experience as well as factors that may promote or discourage linkage to HIV care. We conducted in-depth interviews with patients (n=24) whose HIV infection was diagnosed in the ED/UC of a public hospital in San Francisco at least six months prior and who linked to HIV care at the hospital HIV clinic. Key diagnosis experience themes included physical discomfort and limited functionality, presence of comorbid diagnoses, a wide spectrum of HIV risk perception, and feelings of isolation and anxiety. Patients diagnosed with HIV in the ED/UC may not have their desired emotional supports with them, either because they are alone or they are with family members or friends to whom they do not want to immediately disclose. Other patients may have no one they can rely on for immediate support. Nearly all participants described compassionate disclosure of test results by ED/UC providers, although several noted logistical issues that complicated the disclosure experience. Key linkage to care themes included the importance of continuity between the testing site and HIV care, hospital admission as an opportunity for support and HIV education, and thoughtful matching by linkage staff to a primary care provider. ED/UC clinicians and testing programs should be sensitive to the unique roles of sickness, risk perception, and isolation in the ED/UC diagnosis experience, as these things may delay acceptance of HIV diagnosis. The disclosure and linkage to care experience is crucial in forming patient attitudes towards HIV and HIV care, thus staff involved in disclosure and linkage activities should be trained to deliver compassionate, informed, and thoughtful care that bridges HIV testing and treatment sites.

本研究旨在了解患者对急诊室/急诊护理（Emergency Department/Urgent Care, ED/UC）HIV确诊体验的认知，以及可能促进或阻碍HIV诊疗衔接的相关因素。研究团队对24例患者开展了深入访谈：这些患者至少于6个月前在旧金山某公立医院的急诊室/急诊护理确诊HIV感染，且已在该院HIV诊所完成HIV诊疗衔接。确诊体验的核心主题包括：身体不适与功能受限、合并症诊断、广泛的HIV风险认知谱系，以及孤独与焦虑情绪。在急诊室/急诊护理确诊HIV的患者可能无法获得预期的情感支持——要么是孤身一人，要么陪同者为其不愿即刻告知感染情况的亲友；部分患者甚至无任何可即刻求助的支持对象。几乎所有受访者均提及，急诊室/急诊护理的医护人员以共情方式告知了检测结果，但部分受访者指出，流程性问题使得告知体验复杂化。HIV诊疗衔接的核心主题包括：检测场所与HIV诊疗服务的连续性至关重要、住院可为患者提供支持与HIV健康教育、衔接专员为患者合理匹配初级护理提供者。急诊室/急诊护理的医护人员与检测项目应充分关注疾病状态、风险认知与孤独感在急诊确诊过程中的独特影响，此类因素可能延缓患者对HIV诊断结果的接纳。告知过程与诊疗衔接体验对患者形成HIV及HIV诊疗相关态度至关重要，因此参与告知与衔接工作的人员应接受相关培训，以提供共情、知情且周全的服务，打通HIV检测与治疗场所间的衔接壁垒。