Emergency Department Patient Acceptance of Opt-in, Universal, Rapid HIV Screening

Abstract

SYNOPSISObjectives. We assessed emergency department (ED) patient acceptance of opt-in, rapid human immunodeficiency virus (HIV) screening and identified demographic characteristics and HIV testing-history factors associated with acceptance of screening.Methods. A random sample of 18-to 55-year-old ED patients was offered rapid HIV screening. Patient acceptance or decline of screening and the reasons for acceptance or decline were analyzed with multivariable regression models. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated for the logistic regression models.Results. Of the 2,099 participants, 39.3% accepted HIV screening. In a multinomial regression model, participants who were never married/not partnered, did not have private health insurance, and had 12 or fewer years of education were more likely to be screened due to concern about a possible HIV exposure. In a multivariable logistic regression model, the odds of accepting screening were greater among those who were younger than 40 years old (OR 1.61, 95% CI 1.32, 2.00), nonwhite (OR 1.28, 95% CI 1.04, 1.58), not married (OR 1.82, 95% CI 1.44, 2.28), lacking private health insurance (OR 1.40, 95% CI 1.13, 1.74), and who had 12 or fewer years of education (OR 1.43, 95% CI 1.16, 1.75). Despite use of a standardized protocol, patient acceptance of screening varied by which research assistant asked them to be screened. Patients not previously tested for HIV who were white, married, and 45 years or older and who had private health insurance were more likely to decline HIV screening.Conclusions. In an opt-in, universal, ED HIV screening program, patient acceptance of screening varied by demography, which indicates that the impact of such screening programs will not be universal. Future research will need to determine methods of increasing uptake of ED HIV screening that transcend patient demographic characteristics, HIV testing history, and motivation for testing.

Acceptance of Rapid HIV Screening in a Southeastern Emergency Department

“…Nonetheless, the acceptance rate in our program is much higher than that noted in most testing programs that have offered routine HIV screening. [13][14][15][16][17][18][19]28,30 Although many of these routine HIV screening programs demonstrated that over half of the patients tested will accept testing, most used screening models that required separate consent for HIV testing or for study participation and did not use the opt-out approach currently recommended by the CDC. Our findings illustrate that streamlining the consent and counseling procedures and the opt-out approach for HIV testing in health care settings may promote high test acceptance in the ED.…”

“…18 Most routine HIV testing programs did not include testing the pediatric population. [13][14][15]17,32 However, of the studies that tested pediatric patients, few have tested individuals as young as age 13 years, who had the lowest acceptance rate in our program. Because our pediatric patients were often accompanied by a parent, it is possible that parental influence affected test acceptance among pediatric patients.…”

“…The average acceptance rate in EDs performing routine screening is about 51% using screening models that required separate consent for HIV testing or for study participation, not for opt-out screening. [13][14][15][16][17][18][19] The opt-out approach has been found to be more effective in both prenatal and sexually transmitted disease services than traditional opt-in screening, [20][21][22][23][24][25][26] but it is unclear how patients will accept opt-out HIV screening in the ED setting. A cross-sectional survey revealed that 81% of patients surveyed would have agreed to testing using the opt-out method.…”

A Randomized Controlled Trial of the Effects of a Brief Intervention to Increase Chlamydia and Gonorrhea Testing Uptake Among Young Adult Female Emergency Department Patients

“…24 Sample size to test the primary hypothesis of testing uptake difference was estimated using a binomial tests of proportions, with power = 0.80 and alpha = 0.05 and was estimated to be 79 per study arm. To allow for potential attrition during the study (based on our prior research experience, estimated to be between 10 and 15%), we enrolled as many additional participants as possible during the recruitment period.…”

“…Our acceptance for screening is similar to that reported nationally (45%), 1 but not as high as acceptance for STI or HIV testing reported in previous ED studies. 24 In the ED, as in many other health care sites, screenings for STIs are not part of recommended care. 26 However, in our sample, as is the case nationally, the majority of those who are recommended for annual screening for chlamydia and gonorrhea did not accept testing.…”