Abstract
Objective. To determine the prevalence of occult HIV infection in patients who decline routine HIV testing in an urban emergency department. Design, Setting, and Patients. Discarded blood samples were obtained from patients who had declined routine ED HIV testing. After insuring that the samples came from patients not known to be HIV positive, they were deidentified, and rapid HIV testing was preformed using 5 μL of whole blood. Main Outcome Measures. The prevalence of occult HIV infection in those who declined testing compared with prevalence in those who accepted testing. Results. 600 consecutive samples of patients who declined routine HIV screening were screened for HIV. Twelve (2%) were reactive. Over the same period of time, 4845 patients accepted routine HIV testing. Of these, 35 (0.7%) were reactive. The difference in the prevalence of HIV infection between those who declined and those who accepted testing was significant (P = .001). The relative risk of undetected HIV infection in the group that declined testing was 2.74 times higher (95% CI 1.44–5.18) compared with those accepted testing. Conclusion. The rate of occult HIV infection is nearly three-times higher in those who decline routine ED HIV testing compared with those who accept such testing. Interventions are urgently needed to decrease the opt-out rate in routine ED HIV testing settings.
Highlights
The Centers for Disease Control and Prevention (CDC) has estimated that approximately 1–1.2 million people in the US are infected with HIV
A patient was eligible for emergency departments (EDs) HIV screening if he or she was aged 18–64, was not known to be HIV positive, was able to communicate with the screener and had a normal mental status, had not been tested within the prior three months, and had no urgent medical condition that required immediate intervention
The relative risk of occult HIV infection in the group that declined testing was 2.74 compared to the group that accepted testing
Summary
The Centers for Disease Control and Prevention (CDC) has estimated that approximately 1–1.2 million people in the US are infected with HIV. In 2006, the CDC recommended that routine HIV screening be expanded to many outpatient settings including emergency departments (EDs). The CDC recommended that screening for HIV infection be routinely performed for all patients aged 13–64, in settings where the prevalence of undiagnosed HIV infection in the patient population is more than 0.1% [3]. Several emergency departments have instituted these recommendations, including The George Washington University Hospital (GWUH), which began to offer routine opt-out ED HIV testing in September 2006 [4, 5]. 44% of eligible patients decline an ED HIV test, and the HIV seroprevalence rate among those who accepted testing is 0.7% [4, 6]. We performed a study to compare the HIV seroprevalence rate of individuals who declined routine ED testing with that of patients who accepted testing
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