Seroprevalence Study Using Oral Rapid HIV Testing in a Large Urban Emergency Department (original) (raw)
Will Patients “Opt In” to Perform Their Own Rapid HIV Test in the Emergency Department
Annals of Emergency Medicine, 2011
Objective: We evaluate the feasibility and accuracy of existing point-of-care HIV tests performed by an untrained patient compared with the routinely used HIV point-of-care test offered to patients in 2 urban emergency departments (EDs). , patients who had completed a standard HIV oral fluid test performed by a trained health care professional and who were unaware of their results were recruited to perform a rapid point-of-care HIV test. Patients were given a choice of the oral fluid or the fingerstick blood point-of-care test. Evaluation of acceptability to perform the mechanics of the test was accessed by questionnaire. For the "self-test," the participant obtained his or her own sample and performed the test. The patient's results were compared with standard oral fluid results obtained by the health care professional.
The American Journal of Emergency Medicine, 2015
The Centers for Disease Control and Prevention recommends routine opt-out HIV screening in health care settings. Our goal was to evaluate the feasibility and yield of this strategy in the emergency department (ED) and to compare it to the expected yield of physician-directed testing. Methods: This is a cross-sectional study in an urban ED during random shifts over 1 year. Patients were ineligible for screening if they were younger than 18 years or older than 64, a prisoner, a victim of sexual assault, in an ED resuscitation room, or had altered mental status. Research associates administered rapid HIV tests and conducted standardized interviews. The patients' ED physician, blinded to the HIV result, was asked if they would have ordered a rapid HIV test if it had been available. Results: Of 7756 ED patients, 3957 (51%) were eligible for HIV screening, and 2811 (71%) of those did not opt out. Routine testing yielded 9 new HIV cases (0.32% of those tested; 95% confidence interval, 0.16%-0.63%). Physiciandirected testing would have missed most of these infections: 2 of the 785 patients identified by physicians for testing would have been newly diagnosed with HIV (0.25%; 95% confidence interval, 0.04%-1.0%). Of the 9 new HIV cases, 5 established HIV care, and their median CD4 count was 201 cells/μL (range, 71-429 cells/μL). Conclusions: Routine opt-out HIV screening was feasible and accepted by a majority of ED patients. The yield of this strategy only modestly exceeded what may have been observed with physician-directed testing.
AIDS research and treatment, 2012
Study objective. To compare patient satisfaction with emergency department (ED) opt-in and opt-out HIV screening. Methods. We conducted a survey in an urban ED that provided rapid HIV screening using opt-in (February 1, 2007-July 31, 2007) and opt-out (August 1, 2007-January 31, 2008) approaches. We surveyed a convenience sample of patients that completed screening in each phase. The primary outcome was patient satisfaction with HIV screening. Results. There were 207 and 188 completed surveys during the opt-in and opt-out phases, respectively. The majority of patients were satisfied with both opt-in screening (95%, 95% confidence interval [CI] = 92-98) and opt-out screening (94%, 95% CI = 89-97). Satisfaction ratings were similar between opt-in and opt-out phases even after adjusting for age, gender, race/ethnicity, and test result (adjusted odds ratio 1.3, 95% CI = 0.5-3.1). Conclusions. Emergency department patient satisfaction with opt-in and opt-out HIV screening is similarly high.
The American Journal of the Medical Sciences, 2010
Introduction: More than 1,000,000 persons in the United States are living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome, with 24% unaware of their HIV status. In this study, the authors explored patients' attitudes toward HIV testing in academic medical clinics and investigated the possible impact of the 2006 Centers for Disease Control and Prevention (CDC) HIV screening guidelines. Method: Cross-sectional survey study of adult patients in 9 academic internal medicine clinics (response rate 73%). The survey consisted of 76 questions, which assessed demographics, HIV risk factors, knowledge, beliefs, attitudes and characteristics of patient-physician interactions. Patient self-reported HIV testing was the main outcome. Bivariate analyses were performed, and variables with a P-value of Ͻ0.1 were included in a logistic regression model to determine characteristics most associated with HIV testing. Results: Four hundred forty-three patients completed the survey (response rate 73%) and 61% reported being screened for HIV. Physician recommendation (P Ͻ 0.0001), patient's own request (P Ͻ 0.0001), African American race (P Ͻ 0.0001) better knowledge about HIV (P ϭ 0.0002), agreement with CDC recommendations (P Ͻ 0.0001), being comfortable with their doctor (P Ͻ 0.0001) and using street drugs (P Ͻ 0.0001) were all strongly associated with testing. In logistic regression, the only factors that remained statistically significant predictors of patients self-reported HIV testing were a patient's request for testing (OR: 103.3) and patient's knowledge about HIV (OR: 1.3). Conclusion: In this study, patient request was the strongest predictor for HIV screening and majority of patients accepted the idea of HIV testing in congruence with the CDC recommendations. Therefore, simple waiting room prompts and public education campaigns may represent the most efficient interventions to increase HIV testing rate.
Factors Associated with Refusal of Rapid HIV Testing in an Emergency Department
AIDS and Behavior, 2011
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 selfadministered 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.
Annals of Emergency Medicine, 2008
Prevention (CDC) recently released revised recommendations for HIV testing in health care settings, calling for the performance of nontargeted opt-out HIV screening, the integration of informed consent for HIV testing into the general consent for medical care, and the uncoupling of prevention counseling and testing. It is unclear, however, whether patients will understand opt-out screening or be satisfied with integration of the consent for HIV testing into the general medical consent or the uncoupling of counseling from testing. The objective of this study is to evaluate patients' acceptance of the CDC's revised recommendations in an urban emergency department (ED).
Public health reports (Washington, D.C. : 1974)
The Centers for Disease Control and Prevention has developed guidelines for determining HIV seroprevalence among patients seeking medical care at acute-care hospitals. The guidelines enable hospital staff members to perform a simple, rapid, and inexpensive survey to determine seroprevalence among the patient population, protecting the anonymity of those who are tested. The guidelines are based on national experience with large-scale anonymous, unlinked HIV serosurveys. The data from a rapid assessment survey are particularly useful for evaluating the need to provide routine, voluntary HIV counseling and testing and treatment for HIV infection. Beyond that, such data can be used in targeting education efforts, in reinforcing the use of appropriate universal precautions, in resource allocation, and in determining the need for further studies of HIV infection among the population in the hospital catchment area.
Provider and Practice Characteristics Associated with Use of Rapid HIV Testing by General Internists
Journal of General Internal Medicine, 2011
In September 2006, the Centers for Disease Control and Prevention (CDC) recommended HIV screening for all persons aged 13-64 years. 1 Prior to this, screening targeted individuals with high-risk behaviors and settings, and pregnant women. The rationale for expanded screening is that early diagnosis can reduce morbidity and mortality, 2 and persons who know their HIV status can modify their behaviors and reduce transmission. 3 Furthermore, as of 2006 an estimated 21% of persons with HIV were unaware of their status. 4 Recently, the American College of Physicians and the HIV Medicine Association endorsed the CDC's screening recommendation. 5 The CDC recommendations recognize the potential role of rapid HIV testing to increase adoption of routine HIV testing. Rapid HIV testing became more consistently accessible in 2003 and may have reduced some barriers for testing. 6 Rapid HIV tests yield results in 20 to 30 min and can be performed on either saliva or whole blood. Sensitivity and specificity of commercially available rapid tests are over 99%, 7 although specificity may be lower in actual practice. 8-13 Research has focused on use of rapid testing in episodic care settings such as emergency rooms, 11-15 hospitals, 16 STD clinics, 17 and jails and prisons. 9,18 In these settings, rapid testing is acceptable and associated with a reduction of loss to follow-up after a positive HIV test. 9,16,17,19 Therefore, the CDC Electronic supplementary material The online version of this article