HIV Testing in a Resource-Poor Urban Emergency Department

Glick, Nancy; Silva, Abigail; Zun, Leslie S.; Whitman, Steven

doi:10.1521/aeap.16.2.126.29391

Cited by 43 publications

(27 citation statements)

References 9 publications

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“…1 EDs are desirable locations for HIV screening, as shown by research demonstrating that EDs in some communities provide medical care for large numbers of undiagnosed HIV-infected people [2][3][4][5][6][7][8] and those at risk of HIV infection. [2][3][4]6,7,9,10 Additionally, many EDs in the U.S. provide care for people without regular sources of medical care who might not get tested for HIV elsewhere. 11,12 Although HIV screening in EDs might be a good idea, patient acceptance of ED HIV screening has not been fully elucidated.…”

Section: Public Health Reports / 2008 Supplement 3 / Volume 123mentioning

confidence: 99%

“…U.S. ED-based voluntary HIV testing studies have reported a wide range of estimates of the proportion of patients (29.0% to 98.3%) accepting HIV testing in EDs. 2,3,[5][6][7]9,[13][14][15][16][17] (A summary of these published reports of U.S. ED HIV testing programs from 1993 through 2007 can be found at http://www.brown .edu/Departments/BRUNAP/US_ED_HIV_screening _programs.pdf.) All of these testing programs employed some variation of an opt-in approach in which patients were asked if they would like to be tested, as opposed to an opt-out approach in which patients were informed they would be tested unless they declined.…”

Section: Public Health Reports / 2008 Supplement 3 / Volume 123mentioning

confidence: 99%

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

et al. 2008

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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.

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Section: Public Health Reports / 2008 Supplement 3 / Volume 123mentioning

confidence: 99%

Section: Public Health Reports / 2008 Supplement 3 / Volume 123mentioning

confidence: 99%

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

et al. 2008

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“…Past efforts have centered primarily on the feasibility and yield of conducting HIV testing in this specific clinical environment, [8][9][10][11][12][13][14][15][16][17][18][19] and several ED-based rapid testing strategies have attempted to increase the yield of patients diagnosed with HIV infection. 8,9,[12][13][14][15][16][17][18]20 In recent years, rapid HIV testing methods have been proposed and evaluated in a growing but still limited fashion. A recently published paradigm categorized ED-based rapid HIV testing into diagnostic testing (i.e., testing based on clinical signs or symptoms), targeted testing or screening (i.e., testing a population based on specific risk characteristics), or nontargeted screening (i.e., testing a population regardless of risk).…”

Section: Introductionmentioning

confidence: 99%

Design and Implementation of a Controlled Clinical Trial to Evaluate the Effectiveness and Efficiency of Routine Opt‐out Rapid Human Immunodeficiency Virus Screening in the Emergency Department

Haukoos

Hopkins²,

Byyny³

et al. 2009

Academic Emergency Medicine

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In 2006, the Centers for Disease Control and Prevention (CDC) released revised recommendations for performing human immunodeficiency virus (HIV) testing in health care settings, including implementing routine rapid HIV screening, the use of an integrated opt-out consent, and limited prevention counseling. Emergency departments (EDs) have been a primary focus of these efforts. These revised CDC recommendations were primarily based on feasibility studies and have not been evaluated through the application of rigorous research methods. This article describes the design and implementation of a large prospective controlled clinical trial to evaluate the CDC's recommendations in an ED setting. From April 15, 2007, through April 15, 2009, a prospective quasi-experimental equivalent time-samples clinical trial was performed to compare the clinical effectiveness and efficiency of routine (nontargeted) opt-out rapid HIV screening (intervention) to physician-directed diagnostic rapid HIV testing (control) in a highvolume urban ED. In addition, three nested observational studies were performed to evaluate the costeffectiveness and patient and staff acceptance of the two rapid HIV testing methods. This article describes the rationale, methodologies, and study design features of this program evaluation clinical trial. It also provides details regarding the integration of the principal clinical trial and its nested observational studies. Such ED-based trials are rare, but serve to provide valid comparisons between testing approaches. Investigators should consider similar methodology when performing future ED-based health services research.

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“…[7][8][9][10] HIV infection is, however, increasing among populations that were not considered high-risk populations, such as young people, women, racial and ethnic minorities, persons residing outside metropolitan areas, and heterosexual men and women who are frequently unaware of their HIV risk. 11 Thus, in 2006, the Centers for Disease Control and Prevention (CDC) changed their previous recommendation on risk-based HIV testing in health care settings.…”

mentioning

confidence: 99%

Acceptance of Rapid HIV Screening in a Southeastern Emergency Department

Freeman

Sattin

Miller

et al. 2009

Academic Emergency Medicine

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Objectives: The objective was to assess the acceptance of an emergency department (ED) human immunodeficiency virus (HIV) screening program based on the Centers for Disease Control and Prevention (CDC) recommendations for routine HIV screening in health care settings.Methods: Rapid HIV screening was offered on an opt-out basis to patients aged 13 to 64 years presenting to the ED by trained HIV counselors. Patients were excluded if they had a history of HIV, were physically or mentally incapacitated, did not understand their right to opt-out, or did not speak English or Spanish. Statistical analyses, including logistic regression, were performed to assess the associations between the demographics of patients offered testing and their test acceptance or refusal.Results: From March 2008 to January 2009, a total of 5,080 (91%) of the 5,585 patients offered the HIV test accepted, and 506 (9%) refused. White and married patients were less likely to accept testing than those who were African American and unmarried (p < 0.001). Adult patients were almost twice as likely to accept testing as pediatric patients (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.50 to 2.53). As age increased among pediatric patients, testing refusal decreased (OR = 0.71; 95% CI = 0.59 to 0.85), and as age increased among adult patients, testing refusal increased (OR = 1.17; 95% CI = 1.12 to 1.22). Two percent of persons accepting the test were considered high risk. Males were more likely to report high-risk behavior than females (OR = 1.83; 95% CI = 1.23 to 2.72).

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HIV Testing in a Resource-Poor Urban Emergency Department

Cited by 43 publications

References 9 publications

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

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

Design and Implementation of a Controlled Clinical Trial to Evaluate the Effectiveness and Efficiency of Routine Opt‐out Rapid Human Immunodeficiency Virus Screening in the Emergency Department

Acceptance of Rapid HIV Screening in a Southeastern Emergency Department

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