Opt-ing out: A multivariate analysis of refusal of free, rapid HIV testing in an urban emergency department

Background:The Centers for Disease Control recommends non-targeted opt-out HIV screening in all health care settings, including emergency departments. This guideline is particularly important in the District of Columbia, where an estimated 2.7% of the population is living with HIV. Success of this recommendation depends on patient acceptance of testing. 

Methods: A sample of 300 patients, 18 years of age or older, presenting at the MedStar Georgetown University Hospital Emergency Department (ED) were offered an HIV test, followed by a 40-item survey measuring demographics, risk factors, and attitudes towards testing. Bivariate analysis was conducted, using chi-squared tests, on those who accepted and refused HIV testing followed by a multivariate logistic regression.

Results: Factors independently associated with refusing an HIV test, after adjusting for covariates, included having seen a primary care physician in the last year [OR 4.73 (95% CI 2.03 – 11.02)], past HIV testing [OR 4.26 (1.63 – 11.10)], consistent condom use [OR 2.62 (1.09 – 6.28)], and others in the room when approached for testing [OR 2.53 (1.19 – 5.36)]. Conversely, patients without private insurance [OR 0.17 (0.05 – 0.58)] and those who had ever engaged in anal sex [OR 0.27 (0.10 – 0.71)] had a decreased odds of refusing HIV testing.

Conclusions: Patients reporting consistent access to primary care and low-risk behaviors were more likely to refuse testing. As patients were more likely to refuse testing when others were present in the room, testing protocols in the emergency department should be modified to reflect this preference.