Abstract
IntroductionSince 2008, the Singapore Ministry of Health (MOH) has expanded HIV testing by increasing anonymous HIV test sites, as well as issuing a directive to hospitals to offer routine voluntary opt out inpatient HIV testing. We reviewed this program implemented at the end of 2008 at Tan Tock Seng Hospital (TTSH), the second largest acute care general hospital in Singapore.Methods and FindingsFrom January 2009 to December 2010, all inpatients aged greater or equal than 21 years were screened for HIV unless they declined or were not eligible for screening. We reviewed the implementation of the Opt Out testing policy. There were a total of 93,211 admissions; 41,543 patients were included based on HIV screening program eligibility criteria. Among those included, 79% (n = 32,675) opted out of HIV screening. The overall acceptance rate was 21%. Majority of eligible patients who were tested (63%) were men. The mean age of tested patients was 52 years. The opt out rate was significantly higher among females (OR: 1.5, 95%CI: 1.4–1.6), aged >60 years (OR: 2.3, 95%CI: 2.2–2.4) and Chinese ethnicity (OR: 1.7, 95%CI:1.6–1.8). The false positive rate of the HIV screening test is 0.56%. The proportion of patients with HIV infection among those who underwent HIV screening is 0.18%. All16 confirmed HIV patients were linked to care.ConclusionThe default opt-in rate of inpatient HIV testing was low at Tan Tock Seng Hospital, Singapore. Efforts to address individual HIV risk perception and campaigns against HIV stigma are needed to encourage more individuals to be tested for HIV.
Highlights
Since 2008, the Singapore Ministry of Health (MOH) has expanded HIV testing by increasing anonymous HIV test sites, as well as issuing a directive to hospitals to offer routine voluntary opt out inpatient HIV testing
The default opt-in rate of inpatient HIV testing was low at Tan Tock Seng Hospital, Singapore
From 2008 to the present, the MOH has expanded HIV testing by increasing the number of anonymous HIV test sites, making rapid HIV tests available, as well as issuing a directive to hospitals to offer routine voluntary screening with opt out inpatient HIV testing. These recommendations followed more recent United States Centers for Disease Control guidelines on HIV screening [3], and the results of an unlinked, anonymous HIV seroprevalence survey conducted by the Singapore MOH in 2007 in 5 public hospitals which reported the prevalence of undiagnosed HIV infection at 0.28% [4]
Summary
Since 2008, the Singapore Ministry of Health (MOH) has expanded HIV testing by increasing anonymous HIV test sites, as well as issuing a directive to hospitals to offer routine voluntary opt out inpatient HIV testing. From 2008 to the present, the MOH has expanded HIV testing by increasing the number of anonymous HIV test sites, making rapid HIV tests available, as well as issuing a directive to hospitals to offer routine voluntary screening with opt out inpatient HIV testing These recommendations followed more recent United States Centers for Disease Control guidelines on HIV screening [3], and the results of an unlinked, anonymous HIV seroprevalence survey conducted by the Singapore MOH in 2007 in 5 public hospitals which reported the prevalence of undiagnosed HIV infection at 0.28% [4].
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