title: Payer status, race/ethnicity, and acceptance of free routine opt-out rapid HIV screening among emergency department patients.
abstract: OBJECTIVE
  We estimated associations between payer status, race/ethnicity, and acceptance of nontargeted opt-out rapid HIV screening in the emergency department (ED).
  
  
  METHODS
  We analyzed data from a prospective clinical trial between 2007 and 2009 at Denver Health. Patients in the ED were offered free HIV testing. Patient demographics and payer status were collected, and we used multivariable logistic regression to estimate associations with HIV testing acceptance.
  
  
  RESULTS
  A total of 31,525 patients made 44, 765 unique visits: 40% were White, 37% Hispanic, 14% Black, 1% Asian, and 7% unknown race/ethnicity. Of all visits, 10 ,237 (23%) agreed to HIV testing; 27% were self-pay, 23% state-sponsored, 18% Medicaid, 13% commercial insurance, 12% Medicare, and 8% another payer source. Compared with commercial insurance patients, self-pay patients (odds ratio [OR] = 1.63; 95% confidence interval [CI] = 1.51, 1.75), state-sponsored patients (OR = 1.64; 95% CI = 1.52, 1.77), and Medicaid patients (OR = 1.24; 95% CI = 1.14, 1.34) had increased odds of accepting testing. Compared with White patients, Black (OR = 1.29; 95% CI = 1.21, 1.38) and Hispanic (OR = 1.17; 95% CI = 1.11, 1.23) patients had increased odds of accepting testing.
  
  
  CONCLUSIONS
  Many ED patients are uninsured or subsidized through government programs and are more likely to consent to free rapid HIV testing.
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA. jeffrey.sankoff@dhha.org
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Sankoff
authors.forename: Emily
authors.initials: E
authors.lastname: Hopkins
authors.forename: Comilla
authors.initials: C
authors.lastname: Sasson
authors.forename: Alia
authors.initials: A
authors.lastname: Al-Tayyib
authors.forename: Brooke
authors.initials: B
authors.lastname: Bender
authors.forename: Jason S
authors.initials: JS
authors.lastname: Haukoos
mesh_terms: D000328:Adult; D002986:Clinical Trials as Topic; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000208:ethnology*; D006801:Humans; D019458:Insurance Coverage / Q000145:classification* / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008483:Medical Assistance / Q000706:statistics & numerical data; D008875:Middle Aged; D012959:Socioeconomic Factors