title: Emergency department patient acceptance of opt-in, universal, rapid HIV screening.
abstract: OBJECTIVE
  We assessed emergency department (ED) patient acceptance of opt-in, rapid human immunodeficiency virus (HIV) screening and identified demographic characteristics and HIV testing-history factors associated with acceptance of screening.
  
  
  METHODS
  A random sample of 18- to 55-year-old ED patients was offered rapid HIV screening. Patient acceptance or decline of screening and the reasons for acceptance or decline were analyzed with multivariable regression models. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated for the logistic regression models.
  
  
  RESULTS
  Of the 2,099 participants, 39.3% accepted HIV screening. In a multinomial regression model, participants who were never married/not partnered, did not have private health insurance, and had 12 or fewer years of education were more likely to be screened due to concern about a possible HIV exposure. In a multivariable logistic regression model, the odds of accepting screening were greater among those who were younger than 40-years-old (OR=1.61, 95% CI 1.32, 2.00), nonwhite (OR=1.28, 95% CI 1.04, 1.58), not married (OR=1.82, 95% CI 1.44, 2.28), lacking private health insurance (OR=1.40, 95% CI 1.13, 1.74), and who had 12 or fewer years of education (OR=1.43, 95% CI 1.16, 1.75). Despite use of a standardized protocol, patient acceptance of screening varied by which research assistant asked them to be screened. Patients not previously tested for HIV who were white, married, and 45 years or older and who had private health insurance were more likely to decline HIV screening.
  
  
  CONCLUSIONS
  In an opt-in, universal, ED HIV screening program, patient acceptance of screening varied by demography, which indicates that the impact of such screening programs will not be universal. Future research will need to determine methods of increasing uptake of ED HIV screening that transcend patient demographic characteristics, HIV testing history, and motivation for testing.
authors.affiliation: Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA. rmerchant@lifespan.org
authors.forename: Roland C
authors.initials: RC
authors.lastname: Merchant
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Clark
authors.forename: Victor G
authors.initials: VG
authors.lastname: DeGruttola
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Becker
mesh_terms: D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D012237:Rhode Island; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult