Elissa M Schechter-Perkins1, Elisa Koppelman2, Patricia M Mitchell3, Jake R Morgan4, Randie Kutzen5, Mari-Lynn Drainoni6. 1. Department of Emergency Medicine, Boston University School of Medicine. Electronic address: Elissa.schechter@bmc.org. 2. Department of Health Policy and Management, Boston University School of Public Health; Center for Healthcare Organization and Implementation Research, ENRM Veterans Hospital. 3. Department of Emergency Medicine, Boston University School of Medicine. 4. Department of Health Policy and Management, Boston University School of Public Health. 5. Department of Internal Medicine, Boston University School of Medicine. 6. Department of Health Policy and Management, Boston University School of Public Health; Center for Healthcare Organization and Implementation Research, ENRM Veterans Hospital; Department of Internal Medicine, Boston University School of Medicine.
Abstract
PURPOSE: Understanding differences between patients who accept and decline HIV testing is important for developing methods to reduce decliner rates among patients at risk for undiagnosed HIV. The objectives of this study were to determine the rates of acceptance and reasons for declining, and to determine if differences exist in patient or visit characteristics between those who accept and decline testing. BASIC PROCEDURES: This was a retrospective medical record review of all patients offered an emergency department (ED) HIV test from 11/1/11 to 10/31/12. Patient demographic characteristics, health characteristics, and ED visit characteristics were compared to assess differences between those who accept and those who decline testing. FINDINGS: Of 4510 ED patients offered an HIV test, 3470 accepted for an acceptance rate of 77%. The most common reasons for declining were "no perceived risk" and "tested in the last 3 months." Those who accepted testing were more likely to be unmarried, less than age 35, Hispanic or African American, Spanish speaking, foreign born, have no primary care provider, report no pain at triage, have a daytime ED visit, and be discharged from the ED compared to admitted. Sex, employment status, and ED length of stay did not affect whether patients accepted testing. PRINCIPAL CONCLUSIONS: Acceptance of ED-based rapid HIV testing is not universal, and there are both patient and visit characteristics consistently associated with declining testing. This detracts from the goal of using the ED to screen a large number of at-risk patients who do not have access to testing elsewhere.
PURPOSE: Understanding differences between patients who accept and decline HIV testing is important for developing methods to reduce decliner rates among patients at risk for undiagnosed HIV. The objectives of this study were to determine the rates of acceptance and reasons for declining, and to determine if differences exist in patient or visit characteristics between those who accept and decline testing. BASIC PROCEDURES: This was a retrospective medical record review of all patients offered an emergency department (ED) HIV test from 11/1/11 to 10/31/12. Patient demographic characteristics, health characteristics, and ED visit characteristics were compared to assess differences between those who accept and those who decline testing. FINDINGS: Of 4510 ED patients offered an HIV test, 3470 accepted for an acceptance rate of 77%. The most common reasons for declining were "no perceived risk" and "tested in the last 3 months." Those who accepted testing were more likely to be unmarried, less than age 35, Hispanic or African American, Spanish speaking, foreign born, have no primary care provider, report no pain at triage, have a daytime ED visit, and be discharged from the ED compared to admitted. Sex, employment status, and ED length of stay did not affect whether patients accepted testing. PRINCIPAL CONCLUSIONS: Acceptance of ED-based rapid HIV testing is not universal, and there are both patient and visit characteristics consistently associated with declining testing. This detracts from the goal of using the ED to screen a large number of at-risk patients who do not have access to testing elsewhere.
Authors: Aditi Rao; Caitlin Kennedy; Pamela Mda; Thomas C Quinn; David Stead; Bhakti Hansoti Journal: South Afr J HIV Med Date: 2020-07-22 Impact factor: 2.744
Authors: Cassie Wicken; Ama Avornu; Carl A Latkin; Melissa A Davey-Rothwell; Jim Kim; Raza Zaidi; Richard Rothman; Yu-Hsiang Hsieh Journal: J Infect Public Health Date: 2019-08-01 Impact factor: 3.718
Authors: Anne M Neilan; Alexander J B Bulteel; Sybil G Hosek; Julia H A Foote; Kenneth A Freedberg; Raphael J Landovitz; Rochelle P Walensky; Stephen C Resch; Pooyan Kazemian; A David Paltiel; Milton C Weinstein; Craig M Wilson; Andrea L Ciaranello Journal: Clin Infect Dis Date: 2021-10-05 Impact factor: 9.079