Determinants of patient acceptance and barriers to rapid HIV screening in the Denver Health Emergency Department

Abstract

Although HIV rates have decreased significantly in the United States, the disease continues to disproportionately effect certain populations and remains a high priority public health concern. In 2006, the Centers for Disease Control and Prevention revised the HIV testing recommendations, calling for routine screening in all healthcare settings where the undiagnosed prevalence is ≥0.1%. The Denver Health emergency department (ED) has been at the forefront of studying the complexities of routine HIV screening in an urban ED setting. In 2009, they conducted nested cross-sectional surveys to measure patient HIV risk, demographics, HIV screening perceptions, and ED satisfaction during a nontargeted opt-out screening trial. The aims of this study were to identify patient screening perceptions, risk behaviors, and demographics that influenced a patient’s probability of accepting or declining an HIV test. Using the Denver HIV Risk Score, all patients in the analysis had a validated measure of their objective HIV risk. There were two separate analyses cohorts used in this study. The first included all patients who were offered a rapid HIV test to examine the factors that impacted test acceptance patterns. The second cohort only included patients who declined rapid HIV testing to examine the factors that impacted barriers to HIV testing. Based on our results there were several notable findings and trends. Patients with a higher risk of HIV were also more likely to accept the rapid HIV test. Additionally, patients with a higher risk of HIV were also more likely to be afraid of their HIV test results and feel at higher risk for HIV infection. Probability of testing acceptance differed significantly by race, prior HIV tests, and attitude towards routine HIV testing in the emergency department. Although more weakly associated, test acceptance also varied by patient age. In addition to HIV risk, an increased number of sexual partners and a lower education level were associated with high odds of fearing the HIV test result. Results from the univariate analysis showed that fear of the HIV test results differed by relationship status, sexual orientation, sex with the same gender, and injection of street drugs.