Abstract
Background: HIV infections are generally asymptomatic, leading to undetected infections and late-stage diagnoses. There are a lack of acceptable testing strategies for routine opt-out HIV screening. Our aim was to evaluate and compare the diagnostic yield of routine opt-out HIV testing strategies in two out-patient settings in a low HIV prevalence country: The public primary care and specialist out-patient care settingMethods: A cross-sectional study was conducted in a primary care clinic over a four-week period in 2016 to 2017 and in a specialist out-patient clinic over a concurrent 11-month period. Patients were invited to complete a questionnaire assessing demographic characteristics, acceptance of opt-out HIV testing as a policy in all out-patient clinics in Hong Kong and reasons if refusing the HIV test. All respondents were offered an HIV test.Results: This study included 648 and 1,603 patients in the primary care and specialist out-patient clinic, respectively. Test acceptability was 86 and 87% in the primary care and specialist out-patient setting, respectively. Test uptake was 35 and 68% in the primary care and specialist out-patient setting, respectively. No HIV infections were detected.Conclusion: Opt-out HIV testing during routine blood taking in the specialist out-patient setting achieved a high test uptake and acceptability. In contrast, opt-out HIV testing using rapid finger-prick tests in the primary care setting was not effective.
Highlights
Human Immunodeficiency Virus (HIV), one of the most serious public health issues worldwide, generally presents as a non-specific flu-like illness followed by an asymptomatic period of a decade or longer, with a quarter of infections remaining undiagnosed [1, 2]
Patients will not be too ill to participate in the study and extra venipuncture can be avoided by incorporating HIV testing into routine blood-taking or using finger-prick test
Dried blood spot finger-prick test was administered at the primary care clinic, while blood for HIV testing was taken during routine blood-taking at the phlebotomy centre for hepatology patients
Summary
Human Immunodeficiency Virus (HIV), one of the most serious public health issues worldwide, generally presents as a non-specific flu-like illness followed by an asymptomatic period of a decade or longer, with a quarter of infections remaining undiagnosed [1, 2]. Strategies to detect HIV in the general population have produced varying results, with acceptance rates at in-patient settings as low as 21–24% and more than half of patients excluded from the study as they were too ill. Patients will not be too ill to participate in the study and extra venipuncture can be avoided by incorporating HIV testing into routine blood-taking or using finger-prick test. HIV infections are generally asymptomatic, leading to undetected infections and late-stage diagnoses. There are a lack of acceptable testing strategies for routine opt-out HIV screening. Our aim was to evaluate and compare the diagnostic yield of routine opt-out HIV testing strategies in two out-patient settings in a low HIV prevalence country: The public primary care and specialist out-patient care setting
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