Acceptance of Rapid HIV Testing among Medical Inpatients in New York City

Abstract

Early diagnosis of HIV infection is important for both individual and public health. This study examined patient acceptability of routine, voluntary HIV testing in a New York City hospital serving East Harlem, a diverse community with an HIV seroprevalence of 2.6%. Consecutive admissions to the general medicine service were screened for enrollment between October 27 and November 22, 2005, and March 13 and May 9, 2006. Participants completed a self-administered printed survey and underwent rapid HIV testing. Of the 420 patients approached, 100 patients participated. The most common reason for declining participation was, "I feel too sick to participate." Participants were more likely to be men (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.05, 2.77) and to be in a younger age group (20-49 years; OR 2.70, 95% CI 1.64, 4.45). Participants who reported one or more HIV risk factors were not more likely to answer "Yes" when responding to the statement, "I have risk factors for HIV" compared to patients who did not report any specific clinical or behavioral HIV risk factors (OR = 1.16, 95% CI 0.38,3.53). In addition, patients who reported one or more specific clinical and/or behavioral HIV risk factors were not more likely to have received prior HIV testing (OR = 1.58, 95% CI 0.58, 4.32). Three individuals were newly diagnosed with HIV/AIDS. Risk-based testing may be inadequate, as patients do not accurately assess risk and do not seek or accept testing based on risk. Routine, voluntary HIV testing is able to identify patients missed in the risk-based model of HIV testing, expanding the opportunities for timely diagnosis and intervention. In order to fully implement the new Centers for Disease Control and Prevention (CDC) recommendations for routine, voluntary testing, the optimal timing to offer HIV testing to acutely ill inpatients warrants further investigation.

A Routine HIV Screening Program in a South Carolina Community Health Center in an Area of Low HIV Prevalence

“…25,26 We found that older individuals (>50 years) and Medicare recipients were less likely to accept testing. This is most likely due to the patients not perceiving themselves, and=or the providers not perceiving older patients, to be at risk of infection.…”

“…For instance, a study conducted in a high prevalence facility in New York City found that females and those with a history of previous HIV testing were less likely to participate in the routine screening program. 26 Another study in four urgent care centers also found that females were more likely to refuse testing. 25 These characteristics were not associated with test acceptance when HIV testing was routinely offered at MJW CHC.…”

Knowledge of the Centers for Disease Control and Prevention's 2006 Routine HIV Testing Recommendations among New York City Internal Medicine Residents

“…12 We found that current NYC internal medicine residents infrequently order HIV tests despite frequent contact with patients in a high-prevalence setting (i.e., hospitalized patients). As routine HIV testing of hospitalized patients has been proven to be acceptable in inpatient HIV testing studies, 6,13 it is crucial to offer testing to this patient population. If each NYC internal medicine resident ordered 5 HIV tests per month, this would result in 193,020 HIV tests ordered per year, or an additional 118,240 tests annually citywide.…”

Rapid Routine HIV Testing for Psychiatric Inpatients

“…Routine, rapid screening has already proven widely effective at detecting many undiagnosed cases of HIV in medical settings [18][19][20][21], and linking newly diagnosed patients to care [21,22]. The majority of patients who receive an HIV diagnosis have been shown to increase condom use or make additional efforts to lower the risk of transmission [23].…”