244 HIV Testing History, Testing Interest, and HIV Risk-Taking Behaviors Among Adult Accident and Emergency Department Patients in Belize City

Abstract

Testing for HIV in emergency departments (EDs) has been advocated for in developed countries to identify those with an undiagnosed HIV infection who might not be tested elsewhere and link them to care. However, the utility of HIV testing in developing country EDs is not yet well established. Belize has the highest HIV prevalence in Central America yet its EDs do not routinely offer HIV testing. At the Karl Heusner Memorial Hospital Authority (KHMHA) Accident and Emergency Department (A&E) in Belize City, we assessed HIV testing need among the adult population based on prevalence of lack of prior HIV testing, reported risk of HIV infection, and interest in being tested in the ED. Between June and August of 2018, we recruited a random sample of KHMHA A&E patients and surveyed them using an audio computer-assisted self-interviewer. Participants were English-speaking, 18-64 years old, not critically ill or injured, not a prison inmate/under arrest, and were able to provide informed consent. HIV positivity, prior testing prevalence, and reasons for no prior HIV testing were summarized. Reported HIV risk behaviors and HIV testing interest in the A&E were compared by prior HIV testing status. Multivariable logistic regression was used to identify factors associated with lack of previous HIV testing. Of 301 KHMHA A&E patients screened for study eligibility, patient-reported HIV prevalence was 6%. Of the 264 HIV-uninfected participants, 26% never had been tested for HIV. Of the 69 not previously HIV tested, 28% reported never having been offered testing. Of the 264 HIV-uninfected participants, 6.1% reported injection drug use and 49.2% report having condomless sex in the past 10 years. Prevalence of condomless sex with casual and exchange partners was similar for those never HIV tested vs. tested previously (casual: 25% vs. 27%, p<0.87; exchange: 7.4% vs. 9.7%, p<0.81). Belief in the importance of HIV testing for all A&E patients was similar for never HIV tested vs. tested previously (90% vs. 90%; p<0.30). Participants with fewer years of formal education (primary school or less as compared to tertiary education) (aOR: 4.75 [95% CI: 1.8, 12.4]) and males (aOR: 2.81 [95% CI: 1.5, 5.3]) were less likely to have been HIV tested (Table). Absence of prior HIV testing, lack of being offered an HIV test previously, and the high prevalence of reported HIV risk behaviors indicate that that patients in this developing country could benefit from an A&E-based HIV testing program. Furthermore, the overwhelming majority of patients are supportive of being tested for HIV in the A&E.