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

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.