Increasing Willingness to Be Tested for Human Immunodeficiency Virus in the Emergency Department During Off-Hour Tours: A Randomized Trial
Emergency Medicine Department, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA. Sex Transm Dis
(Impact Factor: 2.84).
01/2008; 34(12):1025-9. DOI: 10.1097/OLQ.0b013e31814b96bb
To test a model designed to increase willingness of patients presenting to the emergency department off hours to be tested for human immunodeficiency virus (HIV) by using a pretest counseling video as a substitute for face-to-face counseling.
We conducted a randomized controlled trial comparing the rate of testing in patients randomized to receive video counseling with immediate testing (video group) versus standard care, which was referral to counseling and testing the next day (standard referral group).
Fifty percent of 805 eligible patients consented to participate in the study, indicating willingness to be tested. The HIV testing rate was higher in the video group 92.6% (187 of 202) than in the standard referral group 4.5% (9 of 202) (difference = 88.1%, 95% confidence interval: 83.5%-92.7%). Thirty percent of 187 patients in the video group who were tested returned for their results; 8 of 9 patients in standard care returned to be tested and to get their results.
Half of the patients who were solicited for HIV testing agreed to be tested. When testing was immediate the patient was more likely to have the test completed.
Available from: Ted D Nirenberg
- "One of the most common reasons for declining HIV screening is lack of perception of risk for HIV infection [25,28,30,32,35,39-41,50,51],[53,58,61-64]. Due to the high prevalence of reported sexual risk and alcohol misuse by ED patients, many techniques have been utilized, with mixed results, to increase uptake of HIV screening, including opt-out HIV screening [36,45,54-57,60,61,65], financial incentives , ED staff or clinician-initiated testing [51,54,67], oral fluid sampling for testing , prevention counseling , and video or computer-based interventions [43,68,69]. Although a number of studies have examined alcohol misuse, HIV risk, and HIV screening, there is a paucity of research on the intersection of these issues. "
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Emergency department (ED) patients comprise a high-risk population for alcohol misuse and sexual risk for HIV. In order to design future interventions to increase HIV screening uptake, we examined the interrelationship among alcohol misuse, sexual risk for HIV and HIV screening uptake among these patients.
A random sample of 18-64-year-old English- or Spanish-speaking patients at two EDs during July-August 2009 completed a self-administered questionnaire about their alcohol use using the Alcohol Use Questionnaire, the Alcohol Use Disorders Identification Test (AUDIT), and the HIV Sexual Risk Questionnaire. Study participants were offered a rapid HIV test after completing the questionnaires. Binging (≥ five drinks/occasion for men, ≥ four drinks for women) was assessed and sex-specific alcohol misuse severity levels (low-risk, harmful, hazardous, dependence) were calculated using AUDIT scores. Analyses were limited to participants who had sexual intercourse in the past 12 months. Multivariable logistic regression was used to assess the associations between HIV screening uptake and (1) alcohol misuse, (2) sexual risk for HIV, and (3) the intersection of HIV sexual risk and alcohol misuse. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated. All models were adjusted for patient demographic characteristics and separate models for men and women were constructed.
Of 524 participants (55.0% female), 58.4% identified as white, non-Hispanic, and 72% reported previous HIV testing. Approximately 75% of participants reported drinking alcohol within the past 30 days and 74.5% of men and 59.6% of women reported binge drinking. A relationship was found between reported sexual risk for HIV and alcohol use among men (AOR 3.31 [CI 1.51-7.24]) and women (AOR 2.78 [CI 1.48-5.23]). Women who reported binge drinking were more likely to have higher reported sexual risk for HIV (AOR 2.55 [CI 1.40-4.64]) compared to women who do not report binge drinking. HIV screening uptake was not higher among those with greater alcohol misuse and sexual risk among men or women.
The apparent disconnection between HIV screening uptake and alcohol misuse and sexual risk for HIV among ED patients in this study is concerning. Brief interventions emphasizing these associations should be evaluated to reduce alcohol misuse and sexual risk and increase the uptake of ED HIV screening.
Available from: Chinazo O Cunningham
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ABSTRACT: Undiagnosed HIV infection remains a significant public health problem. To address this, the Centers for Disease Control and Prevention revised testing recommendations, calling for routine opt-out HIV screening among adults in health care settings. However, these recommendations have not been widely implemented in primary care settings. We examined acceptability of opt-out HIV testing in an urban community health center and factors associated with accepting testing. From July 2007 to March 2008, physicians or a designated HIV tester approached patients presenting for primary care visits during 52 clinical sessions at an urban community health center. Patients were told they "would be tested for HIV unless they declined testing." Enzyme-linked immunosorbent assays, which required venipuncture, were used to test for HIV infection. We extracted demographic, clinical, and visit characteristics from medical records and examined associations between these characteristics and accepting HIV testing using logistic regression. Of 300 patients, 35% agreed to HIV testing, with no new HIV infections detected. Common reasons for declining testing were perceived low risk (54.4%) and self-reported HIV testing previously (45.1%). Younger age (adjusted odds ratio [AOR] = 0.97, 95% confidence interval [CI] = 0.96-0.99), Hispanic ethnicity (AOR = 1.78, 95% CI = 1.01-3.14), and having another blood test during the visit (AOR = 6.36, 95% CI = 3.58-11.28) were independently associated with accepting HIV testing. This study questions whether expanding HIV testing by conducting routine opt-out HIV testing in primary care settings is an acceptable strategy. It is important to understand how various testing strategies may affect HIV testing rates. In addition, further exploration of patients' reasons for declining HIV testing in these settings is warranted.
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