Effectiveness of an opting-out strategy for HIV testing: evaluation of 4 years of standard HIV testing in a STI clinic

Abstract Background South Carolina (SC) remains one of the most heavily affected states for both HIV and HCV infections. Males account for the majority of cases. Implementation of universal opt-out testing has improved screening rates but not much has been published describing the characteristics of those who opt out of testing. This becomes important as 10-50% of patients have opted out in previous studies. Methods Between February and August 2019, we conducted a quality improvement (QI) project which implemented opt- out HIV-HCV testing at a single primary care resident clinic in SC with the primary aim of increasing screening rates for HIV-HCV by 50%. Secondary aims included describing the demographic characteristics of the opt-out population. Persons were considered eligible for testing if they were between the ages of 18-65 years for HIV and 18-74 years for HCV. This was prior to the USPSTF 2020 guidelines which recommend HCV screening for adults aged 18-79 years. A retrospective chart review was used to obtain screening rates, opt status and demographic data. Logistic regression and the firth model were used to determine linkages between categorical variables. We present 3-month data. Results 1253 patients were seen between May 1, 2019- July 31, 2019 (See Table 1). 985 (78%) were eligible for HIV testing. 482 (49%) were tested for HIV as a result of our QI project and all tests were negative. 212 (22%) of eligible patients opted out of HIV testing. Males were 1.59 times more likely to opt out (p=0.008). (see Table 2,3) Regarding HCV, 1136 (90.7%) were deemed eligible for testing. 503 (44%) were tested for HCV as a result of our QI project. 12 (2.4%) were HCV antibody positive with viremia. 11 (90%) of antibody positive with viremia cases were in the 1945-1965 birth cohort (see Table 4). 244 (21%) opted out of HCV testing. Males and persons without a genitourinary chief complaint were more likely to opt out (p=0.02). Table 1: Demographic characteristics of the population seen at the internal medicine resident clinic between May- July 2019 Table 2: Relationship between demographic variables and the odds of being tested for HIV or HCV within the last 12 months. Logistic Model. Table 3: Relationship between demographic variables and the odds of opting out of testing for HIV or HCV. Firth Model. Conclusion Although implementation of routine HIV-HCV opt-out testing led to increased screening rates for both HIV and HCV, roughly 1 in 5 eligible patients chose to opt out of testing. Males were more likely to opt out despite accounting for the majority of newly diagnosed HCV cases. Future studies investigating drivers for opting-out in the male population could improve testing and assist with early diagnosis. Table 4: Characteristics of patients newly diagnosed with HCV positive with viremia. Disclosures All Authors: No reported disclosures

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Determinants of antenatal HIV testing in the opt-out approach in Nigeria: findings from the Nigerian Demographic and Health Survey

Journal of Biosocial Science ◽

10.1017/s0021932019000555 ◽

2019 ◽

Vol 52 (4) ◽

pp. 473-490 ◽

Cited By ~ 2

Author(s):

Ekerette Emmanuel Udoh ◽

Boniface Ayanbekongshie Ushie

Keyword(s):

Antenatal Care ◽

Hiv Testing ◽

Health Survey ◽

Rural Women ◽

Multivariate Regression Analysis ◽

Lower Probability ◽

Antenatal Visit ◽

Opting Out ◽

Opt Out ◽

Nationally Representative

AbstractChildren in Nigeria are frequently born with HIV, despite available services to prevent mother-to-child transmission (MTCT). Not offering, or non-acceptance of, HIV testing during antenatal care (ANC) delays anti-retroviral commencement for infected women, thereby increasing the risk of MTCT. This study assessed the determinants of HIV testing during antenatal care in Nigeria using nationally representative data from the 2013 Nigerian Demographic Health Survey. This study included 13,352 women aged 15–49 years who reported having at least one antenatal visit. The outcome variables were HIV testing during ANC and during labour, while socio-demographic and maternal factors, including number of ANC visits, offer of HIV testing during ANC and labour, place of delivery and knowledge and counselling on MTCT, were among the independent variables. Multivariate regression analysis was used to predict HIV testing during ANC and labour. About half (53%) of the women were tested for HIV during antenatal care with 85% of those tested receiving their test results. Only 6% had HIV tests during labour. There was a 33% excess probability of urban women testing during ANC compared with rural women. Never having a previous pregnancy terminated was associated with lower odds of testing during ANC. No counselling on MTCT and no counselling to get tested were associated with a lower probability of testing during ANC. Counselling on the prevention of MTCT is crucial for women’s willingness to be tested, and acceptance of testing. More effort is needed to ensure that providers in Nigeria offer these services to all women, educate women on the dangers of opting out and ensure the earliest commencement of ARV enrolment for those infected.

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Opting out increases HIV testing in a large sexually transmitted infections outpatient clinic

Sexually Transmitted Infections ◽

10.1136/sti.2008.033258 ◽

2008 ◽

Vol 85 (4) ◽

pp. 249-255 ◽

Cited By ~ 57

Author(s):

R L J Heijman ◽

I G Stolte ◽

H F J Thiesbrummel ◽

E van Leent ◽

R A Coutinho ◽

...

Keyword(s):

Hiv Testing ◽

Sexually Transmitted Infections ◽

Outpatient Clinic ◽

Sexually Transmitted ◽

Opting Out

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The Need for Partner Consent Is a Main Reason for Opting Out of Routine HIV Testing for Prevention of Mother-to-Child Transmission in a Rural Ugandan Hospital

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0b013e31802f1303 ◽

2007 ◽

Vol 44 (3) ◽

pp. 366-369 ◽

Cited By ~ 27

Author(s):

Jaco Homsy ◽

Rachel King ◽

Samuel S Malamba ◽

Christine Opio ◽

Julius N Kalamya ◽

...

Keyword(s):

Hiv Testing ◽

Mother To Child Transmission ◽

Child Transmission ◽

Opting Out ◽

Routine Hiv Testing ◽

Mother To Child

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Evaluation of Intensified Provider Initiated Testing and Counselling Program in Harare City, 2017-2018

10.21203/rs.3.rs-17471/v1 ◽

2020 ◽

Author(s):

Edias Mandere ◽

More Mungati ◽

Gloria Gonese ◽

Notion Gombe ◽

Tsitsi Juru ◽

...

Keyword(s):

Hiv Testing ◽

Community Education ◽

Health Workers ◽

Universal Access ◽

Testing Time ◽

Opting Out ◽

High Workload ◽

Ethical Approval ◽

The University ◽

Harare City

Abstract Introduction Knowledge of HIV status remains a challenge despite implementation of various testing strategies including provider-initiated HIV testing (PITC). Harare City intensified provider-initiated HIV testing by targeting testing all eligible clients visiting facilities to achieve the UNAIDS first 95. This study aimed at evaluating the intervention to improve its effectiveness and inform programming decisions for universal access to HIV testing. Methods The study was conducted in Harare City from April to June 2019. Assessment of the intervention was conducted using the logic model approach. Health workers were interviewed using an interviewer administered questionnaire. Exit interviews were conducted for eligible clients >18 years who refused to be tested. HIV screening and testing registers were reviewed using a check list. Ethical approval was obtained from City of Harare and the University of Zimbabwe. Results The median age for clients was 31 and median years in service for health workers was 2. Of the 133 899 clients who were eligible for testing after screening, 74% accepted the test leaving a gap of 26%. However, 47%(n=45) health workers indicated high workload in the morning as the major reason for the leakage. In addition, 36%(n=70) clients indicated long waiting time as the reason for opting out of HIV testing. Conclusion and Recommendation HIV testing coverage for eligible clients was not optimal, 26% opted out. We recommend scaling of community education on the importance of HIV testing. Re-allocation of staff during busy testing time in the morning to easy workload.

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