The Prevalence of Undiagnosed HIV Infection in Those Who Decline HIV Screening in an Urban Emergency Department

M Czarnogorski, J Brown, V Lee, J Oben, I Kuo, R Stern, G Simon, M Czarnogorski, J Brown, V Lee, J Oben, I Kuo, R Stern, G Simon

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.

Figures

Figure 1
Figure 1
Study flow.

References

    1. Campsmith ML, Rhodes P, Hall HI, Green T. HIV prevalence estimates—United States, 2006. Morbidity and Mortality Weekly Report. 2008;57(39):1073–1076.
    1. McQuillan G, Kruszon-Moran D. HIV Infection in the United States Household Population Aged 18–49 Years: results from 1999–2006. 2008, .
    1. Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. Morbidity and Mortality Weekly Report. Recommendations and Reports. 2006;55(RR-14):1–17.
    1. Brown J, Shesser R, Simon G, et al. Routine HIV screening in the emergency department using the new US centers for disease control and prevention guidelines: results from a high-prevalence area. Journal of Acquired Immune Deficiency Syndromes. 2007;46(4):395–401.
    1. Brown J, Shesser R, Simon G. Establishing an ED HIV screening program: lessons from the front lines. Academic Emergency Medicine. 2007;14(7):658–661.
    1. Brown J, Magnus M, Czarnogosrki M, Lee V. Another look at Emergency Department HIV screening in practice: no need to revise expectations. AIDS Research and Therapy. 2010;7(1, article 1)
    1. Brown J, Kuo I, Bellows J, et al. Patient perceptions and acceptance of routine emergency department HIV testing. Public Health Reports. 2008;123(supplement 3):21–26.
    1. Annual Report. Washington, DC, USA: Department of Health; 2009. HIV/AIDS, Hepatitis, STD and TB Epidemiology. Tech. Rep.
    1. Plitt SS, Singh AE, Lee BE, Preiksaitis JK. HIV seroprevalence among women opting out of prenatal HIV screening in Alberta, Canada: 2002–2004. Clinical Infectious Diseases. 2007;45(12):1640–1643.
    1. Crowne DP, Marlowe D. A new scale of social desirability independent of psychopathology. Journal of Consulting Psychology. 1960;24(4):349–354.
    1. CDC. Late versus early testing of HIV—16 Sites, United States, 2000-2003. Morbidity and Mortality Weekly Report. 2003;52(25):581–586.
    1. Calderon Y, Leider J, Hailpern S, et al. High-volume rapid HIV testing in an Urban emergency department. AIDS Patient Care and STDs. 2009;23(9):749–757.
    1. Kelen GD, Hexter DA, Hansen KN, Tang N, Pretorius S, Quinn TC. Trends in human immunodeficiency virus (HIV) infection among a patient population of an inner-city emergency department: implications for emergency department-based screening programs for HIV infection. Clinical Infectious Diseases. 1995;21(4):867–875.
    1. Johnson DF, Sorvillo FJ, Wohl AR, et al. Frequent failed early HIV detection in a high prevalence area: implications for prevention. AIDS Patient Care and STDs. 2003;17(6):277–282.
    1. Stevens P, Keigher S. Systemic barriers to health care access for U.S. women with HIV: the role of cost and insurance. International Journal of Health Services. 2009;39(2):225–243.
    1. District of Columbia HIV/AIDS Epidemiology Update 2008. Government of the District of Columbia, Wahsington, DC, USA, 2009.
    1. Kelen GD, Rothman RE. Emergency department-based HIV testing: too little, but not too late. Annals of Emergency Medicine. 2009;54(1):65–71.
    1. White DAE, Scribner AN, Schulden JD, Branson BM, Heffelfinger JD. Results of a Rapid HIV Screening and Diagnostic Testing Program in an Urban Emergency Department. Annals of Emergency Medicine. 2009;54(1):56–64.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir