title: Rapid HIV testing in a southeastern emergency department serving a semiurban-semirural adolescent and adult population.
abstract: OBJECTIVE
  We determine the feasibility and yield of universal opt-out HIV screening among adolescents and adults in a southeastern emergency department (ED) serving a semiurban-semirural population.
  
  
  METHODS
  Individuals aged 13 to 64 years who visited the ED during specified hours received the OraQuick rapid HIV test (administered by trained counselors) if they did not opt out. Western blot was used to confirm reactive results. Patients were excluded if they had a history of HIV, had been tested within the past year, were physically or mentally incapacitated, did not understand their right to opt out, or did not speak English or Spanish. Basic demographic information was analyzed by using standard descriptive statistics. Measures of diagnostic test performance were calculated for all valid tests.
  
  
  RESULTS
  From March 2008 through August 2009, 91% (n=8,493) of eligible patients accepted testing, and results were valid. Of 41 reactive results, 35 were confirmed HIV positive, 2 were indeterminate by Western blot, and 4 were false positive. Blacks accounted for the largest percentage (0.65%) of newly detected infections, and the percentage among black men (1%) was more than twice the percentage among black women (0.42%). Rapid-test specificity was estimated at 99.95% (95% confidence interval 99.88% to 99.98%). Nearly 75% of patients confirmed as HIV positive kept their first HIV clinic appointment.
  
  
  CONCLUSIONS
  High rates of acceptance of testing in an ED and linkage to HIV care for adolescents and adults with newly detected infection can be achieved by using opt-out testing and trained HIV counselors.
authors.affiliation: Department of Emergency Medicine, Medical College of Georgia, Georgia Health Sciences University, Augusta, GA 30912, USA. rsattin@georgiahealth.edu
authors.forename: Richard W
authors.initials: RW
authors.lastname: Sattin
authors.forename: James A
authors.initials: JA
authors.lastname: Wilde
authors.forename: Arin E
authors.initials: AE
authors.lastname: Freeman
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Miller
authors.forename: James K
authors.initials: JK
authors.lastname: Dias
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015153:Blotting, Western; D003376:Counseling; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D044469:Racial Groups; D012424:Rural Population; D012737:Sex Factors; D015144:Southeastern United States / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult