Implementing an HIV and Sexually Transmitted Disease Screening Program in an Emergency Department

Acceptance of Rapid HIV Screening in a Southeastern Emergency Department

“…35 Other studies have found that African Americans are likely to accept routine testing in ED and urgent care settings. 14,17,18,28,30,37 However, persons tested late in the course of their infection are more likely to be African American or Hispanic, 38 indicating that these populations may have more barriers to accessing or seeking HIV testing. African Americans residing in the south are disproportionately affected by HIV ⁄ AIDS.…”

“…Brown et al 28 also performed an HIV screening program based on the CDC recommendations for testing in health care settings, with an acceptance rate of HIV screening of 53%, which is not appreciably higher than the average acceptance (51%) of other routine screening programs using the opt-in methodology [13][14][15][16][17][18][19] and much lower than ours. Thus, in addition to the use of the opt-out approach, there are several other features of our program that seem to contribute to the higher acceptance rates.…”

“…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.…”

“…16 Other routine testing studies that included both adult and adolescent patients found that younger age groups were more likely to agree to test, 30 while others found no difference in acceptance by age. 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.…”

“…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.…”