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the inclusion criteria. However, the lack of infrastructure, Acknowledgements
systematic medical record-keeping or a patient tracking
process made it challenging to retain all patients who The authors acknowledge the staff in the Nelson Mandela
presented to the ED. Many patients were missing from the Academic Hospital and Mthatha Regional Hospital
records, whereas others were entered multiple times, making emergency departments for making this research possible
it difficult to keep count of the total number of patients. HIV and the HIV Counselling and Testing team for their
counselling and testing services were provided 24 h a day, yet dedication and hard work during the study. The authors
we were only able to approach 48% of patients who presented also acknowledge the contributions of Nomzamo
for care. We believe this is, in part, a result of the high volumes Mvandaba for her assistance as a study coordinator for the
of patients and the quick turnaround time, as well as the WISE study and those of Victoria Chen and Kathryn Clark
time-consuming nature of counselling. Patients enrolled in in data collection and data validation.
the study may be a biased subset of the ED population,
namely, easier to approach, spoke the same language as the Competing interests
HCT counsellors, had milder injuries or conditions and
presented at times when the patient volume was lower. The authors declare that they have no financial or personal
Maintaining confidentiality was challenging given the relationships that may have inappropriately influenced them
limited space – the EDs in both hospitals were in essence in writing this article.
one big room, with beds lined up against each other. Lastly,
the study was human-resource intensive. We had a team of Authors’ contributions
four dedicated HCT staff at all times. Nevertheless, greater B.H. conceived the original idea for the parent study and
staff numbers would have allowed the capture of more study designed the protocol. A.R., P.M. and B.H. coordinated the
subjects. Such a situation would be difficult to sustain in a study and data collection. A.R. carried out data analysis and
low-resource setting such as Mthatha.
prepared the manuscript. C.K., T.C.Q., D.S. and B.H. provided
substantial edits and revisions.
To optimise our strategy and accurately capture data, given
the lack of organisation and clear processes, our data were
collected prospectively, whereby we relied less on recorded Funding information
data and were able to capture most of it in real time. As the This research was supported by the South African Medical
ED is busy and sees high patient volumes, we attempted to Research Council, the Division of Intramural Research, the
collect as much data as efficiently as possible, using a survey National Institute of Allergy and Infectious Diseases,
format with mostly ‘yes’ and ‘no’ questions. However, to National Institutes of Health, and the Johns Hopkins Center
have had a better understanding of patient perspectives, the for Global Health.
study might have been enhanced by in-depth telephone
interviews with a smaller number of patients after they had
left the ED. Data availability statement
The data that support the findings of this study are available
Conclusion on request from the corresponding author, A.R. The data
are not publicly available because they contain sensitive
Our study demonstrated high patient acceptance of the information that could compromise the privacy of research
nationally recommended HCT strategy in an ED setting.
The overall adult prevalence of HIV in the ED was high at participants.
28.1%. Patients who were male, young and not in pain or
critically injured were more likely to accept HCT, critically Disclaimer
supporting the provision of HCT in acute care settings, as it All views expressed in the submitted article are the authors’
successfully captured an important demographic that has own and not an official position of the institutions represented
generally been missed through other testing venues. In or the funders.
addition, the lack of significant correlation in demographic
or clinical characteristics and HCT uptake argues for a References
routine, non-targeted strategy in the ED. Our study further
reveals the need for continued investment to ensure that 1. UNAIDS.UNAIDS data 2019. UNAIDS, Geneva, Switzerland; 2019.
HCT is widely available, with provision to effectively 2. Simbayi LC, Zuma K, Zungu N, et al. South African National HIV prevalence,
incidence and behaviour, and communication survey, 2017. Cape Town: Human
identify and manage pain and trauma. Finally, critical to Sciences Research Council Press; 2019.
embedding HCT in the routine clinical care offered in the 3. UNAIDS. 90-90-90: An ambitious treatment target to help end the AIDS epidemic.
Geneva: UNAIDS; 2014.
ED will be the confidential conduct of HCT that permits 4. UNAIDS. Ending AIDS: Progress towards the 90-90-90 targets. Geneva: UNAIDS;
stigma around HIV infection and testing to be appropriately 2017.
addressed – something that will require further innovation 5. Johnson LF, Chiu C, Myer L, et al. Prospects for HIV control in South Africa: A
and implementation research. model-based analysis. Glob Health Action. 2016;9(1):30314. https://doi.
org/10.3402/gha.v9.30314

http://www.sajhivmed.org.za 209 Open Access