Acceptance of Opt-out Routine Screening for HIV Infection at an Urban Emergency Department Following New Centers for Diseases Control and Prevention (CDC) Guidelines

APHA Scientific Session and Event Listing

3038.0: Monday, November 05, 2007 - 9:30 AM

Abstract #161718

Irene Kuo, PhD, MPH¹, Jeremy Brown, MD², Robert Shesser, MD, MPH², Neal K. Sikka, MD³, Manya Magnus, PhD, MPH⁴, Amanda D. Castel, MD, MPH¹, Gary Simon, MD⁵, Maggie Czarnogorski, MD⁵, and Alan E. Greenberg, MD, MPH¹. (1) Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, 2300 Eye Street NW, Ross Hall Suite 125, Washington, DC 20037, 202-994-0367, sphirk@gwumc.edu, (2) Department of Emergency Medicine, George Washington University School of Medicine, 2150 Pennsylvania Avenue, NW, Suite 2B-417, Washington, DC 20037, (3) Department of Emergency Medicine, The George Washington University, 2150 Pennsylvania Ave, NW, Suite 2-B, Washington, DC 20037, (4) The George Washington University, School of Public Health and Health Sciences, Department of Epidemiology and Biostatistics, 2300 Eye Street, NW, Ross Hall 120b, Washington, DC 20037, (5) Division of Infectious Diseases, George Washington University School of Medicine, 2150 Pennsylvania Avenue, NW, Suite #5-411, Washington, DC 20037

Background: In 2006, CDC issued recommendations for routine HIV testing in emergency departments (ED). The feasibility and acceptance of Washington DC's routine HIV screening campaign following these recommendations were evaluated at an urban university hospital ED. Methods: Patients aged 13-64 seeking care at the ED between September-December 2006 were offered free rapid HIV screening by trained staff. Patients provided verbal consent, and results were provided in 20-40 minutes. Data on demographics, zip code of residence, acceptance of HIV test, and test result were collected. T-test and chi-square analyses were used to describe associations between patient characteristics and test acceptance. Results: 4,151 patients were offered HIV screening. Mean age was 37.5 (SD 12.9); nearly half (48.5%) were black, 39.0% were non-Hispanic white, 4.1% were Hispanic, 1.7% were Asian, and 6.7% responded as other race. More than half were female, and the majority (73.4%) lived in the tri-state area (DC, Maryland or Virginia). Of those offered screening, 59.7% were tested, while 40.3% actively declined. Individuals who declined were older (39.1 vs. 36.4, p<0.001), more likely to be Asian (55.7% Asian vs. 40.1% all other races, p=0.008), and live outside the tri-state area (38.4% tri-state vs. 45.4% outside, p<0.01). Gender was not associated with screening acceptance. The prevalence of preliminary HIV positives was 1.1%. Conclusions: Routine opt-out HIV screening in the ED is feasible and accepted by the majority of patients. Older individuals and Asians were less likely to accept HIV screening. Efforts to increase HIV screening among these specific populations are warranted.

Learning Objectives:

At the end of this presentation, participants will be able to

1) To describe the acceptance of new CDC guidelines for routine HIV screening in an emergency department of an urban hospital.
2) To describe demographic characteristics associated with HIV screening acceptance in the emergency department.
3) To understand challenges of implementing a routine HIV screening program in an emergency department.

Keywords: HIV/AIDS, Screening

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Emerging Issues and Lessons Learned Regarding HIV Screening

The 135th APHA Annual Meeting & Exposition (November 3-7, 2007) of APHA