title: Opt-out of voluntary HIV testing: a Singapore hospital's experience.
abstract: BACKGROUND
  Since 2008, the Singapore Ministry of Health (MOH) has expanded HIV testing by increasing anonymous HIV test sites, as well as issuing a directive to hospitals to offer routine voluntary opt out inpatient HIV testing. We reviewed this program implemented at the end of 2008 at Tan Tock Seng Hospital (TTSH), the second largest acute care general hospital in Singapore.
  
  
  RESULTS
  From January 2009 to December 2010, all inpatients aged greater or equal than 21 years were screened for HIV unless they declined or were not eligible for screening. We reviewed the implementation of the Opt Out testing policy. There were a total of 93,211 admissions; 41,543 patients were included based on HIV screening program eligibility criteria. Among those included, 79% (n = 32,675) opted out of HIV screening. The overall acceptance rate was 21%. Majority of eligible patients who were tested (63%) were men. The mean age of tested patients was 52 years. The opt out rate was significantly higher among females (OR: 1.5, 95%CI: 1.4-1.6), aged >60 years (OR: 2.3, 95%CI: 2.2-2.4) and Chinese ethnicity (OR: 1.7, 95%CI:1.6-1.8). The false positive rate of the HIV screening test is 0.56%. The proportion of patients with HIV infection among those who underwent HIV screening is 0.18%. All 16 confirmed HIV patients were linked to care.
  
  
  CONCLUSIONS
  The default opt-in rate of inpatient HIV testing was low at Tan Tock Seng Hospital, Singapore. Efforts to address individual HIV risk perception and campaigns against HIV stigma are needed to encourage more individuals to be tested for HIV.
authors.affiliation: Department of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore. Arlene_CHUA@ttsh.com.sg
authors.forename: Arlene C
authors.initials: AC
authors.lastname: Chua
authors.forename: Yee Sin
authors.initials: YS
authors.lastname: Leo
authors.forename: Philippe
authors.initials: P
authors.lastname: Cavailler
authors.forename: Christine
authors.initials: C
authors.lastname: Chu
authors.forename: Aloysius
authors.initials: A
authors.lastname: Ng
authors.forename: Oon Tek
authors.initials: OT
authors.lastname: Ng
authors.forename: Prabha
authors.initials: P
authors.lastname: Krishnan
mesh_terms: D000328:Adult; D035041:Anonymous Testing / Q000523:psychology* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000175:diagnosis* / Q000821:virology; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000821:virology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D012737:Sex Factors; D012846:Singapore