Acceptance of Rapid HIV Screening in a Southeastern Emergency Department

Freeman, Arin; Sattin, Richard W.; Miller, Kelly M.; Dias, James W.; Wilde, James A.

doi:10.1111/j.1553-2712.2009.00508.x

Cited by 52 publications

(39 citation statements)

References 35 publications

(77 reference statements)

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“…Opt-out testing resulted in higher test acceptance rates in one study (91%) (Freeman et al, 2009) but not another (53%) (Brown et al, 2007) than the routine testing studies that used an opt-in approach in this analysis for which about 50% of persons accept testing (CDC, 2007;Lyss et al, 2007, Silva et al, 2007, White et al, 2009). …”

Section: Discussionmentioning

confidence: 99%

“…In the existing staff model, triage nursing staff demonstrated the ability to offer HIV screening to a large number of eligible patients. Many patients who were offered and agreed to testing, however, were not tested, likely because of the ED staff's competing clinical responsibilities (Freeman, Sattin, Miller, Dias, Wilde, 2009;White et al, 2009). The supplemental staff model was able to offer testing to fewer patients but tested a higher proportion of patients who accepted.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Emergency Department HIV Screening with Rapid Tests: A Cost Comparison of Alternative Models

Hutchinson

Farnham²,

Lyss³

et al. 2011

AIDS Education and Prevention

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Although previous studies have shown that HIV screening in emergency departments (EDs) is feasible, the costs and outcomes of alternative methods of implementing ED screening have not been examined. We compared the costs and outcomes of a model that used the hospital's ED staff to conduct screening, a supplemental staff model that used non-ED staff hired to conduct screening and a hypothetical hybrid model that combined aspects of both approaches. We developed a decision analytic model to estimate the cost per HIV-infected patient identified using alternative ED testing models. The cost per new HIV infection identified was $3,319, $2,084 and $1,850 under the supplemental, existing staff and hybrid models, respectively. Assuming an annual ED census of 50,000 patients, the existing staff model identified 29 more HIV infections than the supplemental model and the hybrid model identified 76 more infections than the existing staff model. Our findings suggest that a hybrid model should be favored over either a supplemental staff or existing staff model in terms of cost per outcome achieved.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Emergency Department HIV Screening with Rapid Tests: A Cost Comparison of Alternative Models

Hutchinson

Farnham²,

Lyss³

et al. 2011

AIDS Education and Prevention

View full text Add to dashboard Cite

show abstract

“…Freeman et al reported that 91% of patients offered testing in an ED accepted, and they also found that white and married patients were less likely to accept testing. 19 Another study of ED patients by Haukoos et al reported a patient acceptance rate of 81%, regardless of whether testing was opt-out or opt-in. 20 Brown and coworkers reported that 59.7% of ED patients accepted testing.…”

Section: Discussionmentioning

confidence: 99%

Knowledge, Attitudes, and Ordering Patterns for Routine HIV Screening among Resident Physicians at an Urban Medical Center

Bares

Steinbeck

Bence

et al. 2016

J Int Assoc Provid AIDS Care

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Background: We sought to measure resident physician knowledge of HIV epidemiology and screening guidelines, attitudes toward testing, testing practices, and barriers and facilitators to routine testing. Methods: Resident physicians in internal medicine, pediatrics, obstetrics and gynecology, and emergency medicine were surveyed. Results: Overall response rate was 63% (162 of 259). Half knew details of the HIV screening guidelines, but few follow these recommendations. Less than onethird reported always or usually performing routine testing. A significant proportion reported only sometimes or never screening patients with risk factors. This was despite a strong belief that HIV screening improves patient care and public health. The most common barriers to testing were competing priorities and forgetting to order the test. Elimination of written consent and electronic reminders was identified as facilitators to routine testing. Although an institutional policy assigns responsibility for test notification and linkage of HIV-positive patients to care to the HIV care program, only 29% were aware of this. Conclusions: Few resident physicians routinely screen for HIV infection and some don't test patients with risk factors. While competing priorities remain a significant barrier, elimination of written consent form and electronic reminders has facilitated testing. Increasing the awareness of policies regarding test notification and linkage to care may improve screening.

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“…6 ED-based screening programs are feasible and well received by patients. [7][8][9][10][11] However, the majority of studies have been conducted outside of the Deep South. This article is a descriptive report of an ED-based rapid HIV screening program in the Deep South using the 2006 CDC recommendations.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of an Emergency Department-Based HIV Screening Program in the Deep South

et al. 2011

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Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) continue to be a significant public health concern in the United States. It disproportionately affects persons in the Deep South of the United States, specifically African Americans. This is a descriptive report of an Emergency Department (ED)-based HIV screening program in the Deep South using the 2006 Centers for Disease Control and Prevention (CDC) recommendations for rapid testing and opt-out consent. Between May 2008 and March 2010, patients presenting for medical care to the ED Monday through Friday between 10 AM and 10 PM were approached for HIV screening. Patients were eligible for screening if they were 18 or older, had no previous history of positive HIV tests, were English-Speaking, and were not incarcerated, medically unstable, or otherwise able to decline testing. All patients were tested using the OraQuick® rapid HIV 1/2 antibody test. Patients with non-reactive results were referred to community anonymous testing sites for further testing. Patients with reactive results had confirmatory Western blot and CD4 counts drawn and were brought back to the ED for disclosure of the results. All patients with confirmed HIV positive via reactive Western blot were referred to the hospital-based infectious disease clinic or county health department. We tested 7,616 patients out of 8,922 approached. The overall test acceptance rate was 85.4%. 91.0% of patients tested were African American. The most common reason for refusal was recent HIV test. 1.7% of patients tested were confirmed HIV positive via Western blot. 95.2% of patients testing HIV positive were African American. The average CD4 count for patients testing positive was 276 cells/μl, with 42.0% of patients having CD4 counts ≤200 μl, consistent with an AIDS diagnosis. 88.4% of patients who had reactive oral swabs returned for Western blot results and 75.0% of patients attended their first clinic visit. We have been able to successfully carry out an ED-based HIV screening program in a resource-poor urban teaching facility in the Deep South. We define our success based on our relatively high test acceptance rate and high rate of attendance at first clinic visit. Our patient population has a relatively high undocumented HIV prevalence and are at advanced stage of disease at the time of diagnosis.

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Acceptance of Rapid HIV Screening in a Southeastern Emergency Department

Cited by 52 publications

References 35 publications

Emergency Department HIV Screening with Rapid Tests: A Cost Comparison of Alternative Models

Emergency Department HIV Screening with Rapid Tests: A Cost Comparison of Alternative Models

Knowledge, Attitudes, and Ordering Patterns for Routine HIV Screening among Resident Physicians at an Urban Medical Center

Efficacy of an Emergency Department-Based HIV Screening Program in the Deep South

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