151: Emergency Department Patient Acceptance of Rapid HIV Testing Practices, Revisited: The 2006 CDC Recommendations for Non-Targeted, Opt-Out HIV Screening

2009 ◽  
Vol 54 (3) ◽  
pp. S47
Author(s):  
M.E. Prekker ◽  
T. Olives ◽  
O. Hanley ◽  
J.R. Miner
Keyword(s):  
Emergency Department ◽  
Hiv Testing ◽  
Emergency Department Patient ◽  
Patient Acceptance ◽  
Hiv Screening ◽  
Rapid Hiv Testing ◽  
Opt Out ◽  
Testing Practices

scholarly journals Patient Perceptions and Acceptance of Routine Emergency Department HIV Testing

2008 ◽  
Vol 123 (3_suppl) ◽  
pp. 21-26 ◽  
Author(s):  
Jeremy Brown ◽  
Irene Kuo ◽  
Jennifer Bellows ◽  
Ryan Barry ◽  
Peter Bui ◽  
...  
Keyword(s):  
Emergency Department ◽  
African American ◽  
Hiv Testing ◽  
Acceptance Rate ◽  
Patient Acceptance ◽  
Hiv Screening ◽  
Asian Patients ◽  
Academic Center ◽  
Hiv Test ◽  
High Prevalence

Objectives. We report on the rates of patient acceptance and their perceptions of routine emergency department (ED) human immunodeficiency virus (HIV) testing in a high-prevalence area. Methods. We analyzed the race/ethnicity of patients who either accepted or declined a routine HIV test that was offered to all patients in the ED of a large academic center. We also distributed a patient perception survey about ED HIV testing. Results. During the study period, an HIV screening test was offered to 9,826 patients. Of these, 5,232 patients (53%) accepted the test. The acceptance rate of HIV testing was highest among African American patients (55%), followed by 52% for white, 50% for Hispanic, and 42% for Asian patients. A total of 1,519 completed surveys were returned for analysis. The most common reasons for declining a test were that patients did not perceive themselves to be at risk for HIV (49%) or they had recently been tested for HIV (18%). Overall, 84% of patients stated they would recommend to a friend to get an HIV test in the ED. When analyzed by ethnicity, 89% of African American patients stated they would recommend to a friend to get an HIV test if the friend went to the ED, but only 74% of white patients would do so. Conclusions. The Centers for Disease Control and Prevention's 2006 recommendations on HIV screening are well accepted by the target populations. Further work at explaining the risk of HIV infection to ED patients should be undertaken and may boost the acceptance rate of ED HIV screening.

scholarly journals A Comparison of Patient Satisfaction with Emergency Department Opt-In and Opt-Out Rapid HIV Screening

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Douglas A. E. White ◽  
Alicia N. Scribner ◽  
Maria E. Martin ◽  
Stacy Tsai
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Primary Outcome ◽  
Emergency Department Patient ◽  
Hiv Screening ◽  
Convenience Sample ◽  
Study Objective ◽  
Opt Out ◽  
Race Ethnicity ◽  
Test Result

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.

scholarly journals The Prevalence of Undiagnosed HIV Infection in Those Who Decline HIV Screening in an Urban Emergency Department

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
M. Czarnogorski ◽  
J. Brown ◽  
V. Lee ◽  
J. Oben ◽  
I. Kuo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Hiv Screening ◽  
Opt Out ◽  
Undiagnosed Hiv ◽  
Routine Hiv Screening ◽  
The Difference ◽  
Routine Hiv Testing ◽  
Urban Emergency Department

Objective. To determine the prevalence of occult HIV infection in patients who decline routine HIV testing in an urban emergency department.Design, Setting, and Patients. Discarded blood samples were obtained from patients who had declined routine ED HIV testing. After insuring that the samples came from patients not known to be HIV positive, they were deidentified, and rapid HIV testing was preformed using 5 μL of whole blood.Main Outcome Measures. The prevalence of occult HIV infection in those who declined testing compared with prevalence in those who accepted testing.Results. 600 consecutive samples of patients who declined routine HIV screening were screened for HIV. Twelve (2%) were reactive. Over the same period of time, 4845 patients accepted routine HIV testing. Of these, 35 (0.7%) were reactive. The difference in the prevalence of HIV infection between those who declined and those who accepted testing was significant (). The relative risk of undetected HIV infection in the group that declined testing was 2.74 times higher (95% CI 1.44–5.18) compared with those accepted testing.Conclusion. The rate of occult HIV infection is nearly three-times higher in those who decline routine ED HIV testing compared with those who accept such testing. Interventions are urgently needed to decrease the opt-out rate in routine ED HIV testing settings.

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

2008 ◽  
Vol 123 (3_suppl) ◽  
pp. 27-40 ◽  
Author(s):  
Roland C. Merchant ◽  
George R. Seage ◽  
Kenneth H. Mayer ◽  
Melissa A. Clark ◽  
Victor G. DeGruttola ◽  
...  
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Health Insurance ◽  
Regression Model ◽  
Hiv Testing ◽  
Regression Models ◽  
Private Health Insurance ◽  
Demographic Characteristics ◽  
Patient Acceptance ◽  
Hiv Screening

Objectives. 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.

scholarly journals Using a configurable EMR and decision support tools to promote process integration for routine HIV screening in the emergency department

2015 ◽  
Vol 23 (2) ◽  
pp. 396-401 ◽  
Author(s):  
Robert McGuire ◽  
Eric Moore
Keyword(s):  
Emergency Department ◽  
Decision Support ◽  
Hiv Testing ◽  
Screening Program ◽  
Safety Net ◽  
Hiv Screening ◽  
Decision Support Tools ◽  
Opt Out ◽  
Safety Net Hospital ◽  
Support Tools

Abstract Given the clinical and public health benefits of routine Human Immunodeficiency Virus (HIV) testing in the emergency department (ED) and Centers for Disease Control and Prevention recommendations, Maricopa Medical Center, as part of Maricopa Integrated Health System, started Test, Educate, Support, and Treat Arizona (TESTAZ) and became the first and, to-date, only hospital in Arizona to implement routine, non-targeted, opt-out, rapid HIV screening in the ED. The authors describe the implementation of a universal, routine, opt-out HIV screening program in the adult ED of an urban safety-net hospital serving under-served populations, including the uninsured and under-insured. Through a controlled and collaborative process, the authors integrated custom documentation elements specific to HIV screening into the triage/intake process, implemented and utilized clinical decision support tools to guide clinicians in each step of the process, and used electronic data collection and reporting to drive new screening protocols that led to a significant increase in overall HIV testing rates.

scholarly journals 1120. Impact of Training Residents to Improve HIV Screening in a Teaching Hospital in Mexico City

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S590-S590
Author(s):  
Lorena Guerrero-Torres ◽  
Isaac Núñez-Saavedra ◽  
Yanink Caro-Vega ◽  
Brenda Crabtree-Ramírez
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Hiv Testing ◽  
Teaching Hospital ◽  
Educational Intervention ◽  
Temporal Trends ◽  
Hiv Screening ◽  
Hiv Diagnosis ◽  
Post Intervention ◽  
Hiv Test

Abstract Background Among 230,000 people living with HIV in Mexico, 24% are unaware of their diagnosis, and half of newly diagnosed individuals are diagnosed with advanced disease. Early diagnosis is the goal to mitigate HIV epidemic. Missed opportunities may reflect a lack of clinicians’ consideration of HIV screening as part of routine medical care. We assessed whether an educational intervention on residents was effective to 1) improve the knowledge on HIV screening; 2) increase the rate of HIV tests requested in the hospitalization floor (HF) and the emergency department (ED); and 3) increase HIV diagnosis in HF and ED. Methods Internal Medicine and Surgery residents at a teaching hospital were invited to participate. The intervention occurred in August 2018 and consisted in 2 sessions on HIV screening with an expert. A questionnaire was applied before (BQ) and after (AQ) the intervention, which included HIV screening indications and clinical cases. The Institutional Review Board approved this study. Written informed consent was obtained from all participants. BQ and AQ scores were compared with a paired t-test. To evaluate the effect on HIV test rate in the HF and ED, an interrupted time series analysis was performed. Daily rates of tests were obtained from September 2016 to August 2019 and plotted along time. Restricted cubic splines (RCS) were used to model temporal trends. HIV diagnosis in HF and ED pre- and post-intervention were compared with a Fisher’s exact test. A p< 0.05 was considered significant. Results Among 104 residents, 57 participated and completed both questionnaires. BQ score was 79/100 (SD±12) and AQ was 85/100 (SD±8), p< .004. Time series of HIV testing had apparent temporal trends (Fig 1). HIV test rate in the HF increased (7.3 vs 11.1 per 100 episodes) and decreased in the ED (2.6 vs 2.3 per 100 episodes). HIV diagnosis increased in the HF, from 0/1079 (0%) pre-intervention to 5/894 (0.6%) post-intervention (p< .018) (Table 1). Fig 1. HIV test rates. Gray area represents post-intervention period. Table 1. Description of episodes, HIV tests and rates pre- and post-intervention in the Emergency Department and Hospitalization Floor. Conclusion A feasible educational intervention improved residents’ knowledge on HIV screening, achieved maintenance of a constant rate of HIV testing in the HF and increased the number of HIV diagnosis in the HF. However, these results were not observed in the ED, where administrative barriers and work overload could hinder HIV screening. Disclosures All Authors: No reported disclosures

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