Understanding why emergency department patients decline routine HIV testing

Background: Routine HIV testing in hospital emergency departments (EDs) can lead to earlier diagnoses for high-risk patients who have limited access to healthcare. In New York State, ED staff are required to offer HIV testing to all patients aged 13-64, with few exceptions. However, those who could benefit most from routine testing often decline. Understanding why people choose not to test can aid the development of more effective interventions to increase test rates.

Methods: 160 patients who declined HIV testing in a high volume, urban ED were recruited in Summer 2012 and shown a brief (less than 16 minute) computer-based video intervention designed to increase HIV test rates. A subset of participants (n=40) were interviewed afterward about their experience with the intervention, their reasons for initially declining a test, and their thoughts about why others decline.

Results: One third of participants accepted a test following the intervention. In interviews, many participants said others did not test because they feared positive test results and stigma. However, when asked why they declined a test themselves, many participants reported feeling they were low risk and thus did not need to test. Conclusion: The study indicates brief interventions can increase HIV test rates among reluctant patients in high volume clinical settings. Qualitative findings suggest future technology-based interventions may be made more effective by addressing participants' fear, HIV-related stigma, and perceived low self-risk. Studies can employ similar qualitative approaches to refine interventions for greater effectiveness with specific populations.