From Law to Practice, Emergency Department Leaders' Experiences With Universal HIV Testing in New York City: A Qualitative Research Brief.

In 2010, New York State enacted a law that all individuals aged 13 or older seeking care in emergency departments (EDs) be offered HIV testing. This study explored ongoing barriers to implementing this law in high-prevalence settings such as New York City (NYC) more than a decade after its introduction. Nine ED leaders from nine NYC hospitals completed demographic surveys and in-depth interviews focused on perceptions of the law, testing workflows, and implementation challenges. Interview transcripts were independently coded by two trained researchers, using an inductive approach. Six leaders reported that their sites conducted universal testing, typically integrated into nursing workflows. The remaining three cited insufficient staffing, lack of awareness about the mandate, or preference to offer testing based on a patient’s chief complaint. Across all sites, key implementation barriers were resource constraints, time pressures, and concerns about inadequate patient follow-up. Overall, findings indicate that despite the statewide law, offering universal HIV testing is not yet a standard practice across NYC EDs. Strengthening implementation will require specialized workflow integration, particularly in partnership with nursing staff, and additional resources to sustain routine testing practices.