Factors Associated with Refusal of Rapid HIV Testing in an Emergency Department

Abstract

HIV screening studies in the emergency department (ED) have demonstrated rates of HIV test refusal ranging from 40–67%. This study aimed to determine the factors associated with refusal to undergo routine rapid HIV testing in an academic ED in Boston. HIV counselors offered routine testing to 1,959 patients; almost one-third of patients (29%) refused. Data from a self-administered survey were used to determine independent correlates of HIV testing refusal. In multivariate analysis, women and patients with annual household incomes of $50,000 or more were more likely to refuse testing, as were those who reported not engaging in HIV risk behaviors, those previously HIV tested and those who did not perceive a need for testing. Enrollment during morning hours was also associated with an increased risk of refusal. Increased educational efforts to convey the rationale and benefits of universal screening may improve testing uptake among these groups.

Is Self-Perceived HIV Risk Congruent with Reported HIV Risk Among Traditionally Lower HIV Risk and Prevalence Adult Emergency Department Patients? Implications for HIV Testing

“…However, it should be recalled that ED patients typically decline HIV testing out of a belief that they are not at risk for an infection, [53][54][55][56][57][58][59][60][61][62][63][64][65] and many patients who decline testing do have significant risk for having an undiagnosed infection. 21 When an opt-out approach without a risk assessment is used by ED clinicians, patients likely conduct their own risk assessment internally and perhaps subconsciously, and maybe inaccurately.…”

Modest Public Health Impact of Nontargeted Human Immunodeficiency Virus Screening in 29 Emergency Departments

“…However, our subanalysis of reasons for refusal showed that most of both groups' demographics were similar, with the only covariates of refusal being low perceived risk and having previously been tested for HIV, as in other studies. 36,37 One of the objectives of implementing nontargeted HIV screening in the ED is to reach a large segment of the population, including the economically underprivileged and those with poorer access to health care. Moreover, ED recruitment was expected to reach infected persons who did not belong to the main high-risk groups, ie, heterosexual men and couples, who were not targeted by specific screening programs and who are thought to rarely undergo voluntary testing.…”

Hiv/Aids prevalence at the accident & emergency centre of a tertiary and referral health institution in Ghana

“…There may be other factors, apart from those mentioned by Hutchinson 26 and Pisculli 27 , that may be potentially associated with refusal of HIV testing which were not assessed in this study; but it is not possible to comment on these factors from our data. Nonetheless, our data on refusal rate may still be a useful contribution in defining trends in uptake of HIV testing and counselling within Ghana.…”

“…Pisculli et al 27 have associated patients with large household annual income to be more likely to refuse testing, as well as those who reported no HIV risk behaviours, those previously tested for HIV, and those who did not perceive a need for testing.…”