title: Missed opportunities: refusal to confirm reactive rapid HIV tests in the emergency department.
abstract: BACKGROUND
  HIV infection remains a major US public health concern. While HIV-infected individuals now benefit from earlier diagnosis and improved treatment options, progress is tempered by large numbers of newly diagnosed patients who are lost to follow-up prior to disease confirmation and linkage to care.
  
  
  METHODS
  In the randomized, controlled USHER trial, we offered rapid HIV tests to patients presenting to a Boston, MA emergency department. Separate written informed consent was required for confirmatory testing. In a secondary analysis, we compared participants with reactive results who did and did not complete confirmatory testing to identify factors associated with refusal to complete the confirmation protocol.
  
  
  RESULTS
  Thirteen of 62 (21.0%, 95% CI (11.7%, 33.2%)) participants with reactive rapid HIV tests refused confirmation; women, younger participants, African Americans, and those with fewer HIV risks, with lower income, and without primary care doctors were more likely to refuse. We projected that up to four true HIV cases were lost at the confirmation stage.
  
  
  CONCLUSIONS
  These findings underscore the need to better understand the factors associated with refusal to confirm reactive HIV testing and to identify interventions that will facilitate confirmatory testing and linkage to care among these populations.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00502944; NCT01258582.
authors: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
authors: Ishani
authors: I
authors: Ganguli
authors: Jamie E
authors: JE
authors: Collins
authors: William M
authors: WM
authors: Reichmann
authors: Elena
authors: E
authors: Losina
authors: Jeffrey N
authors: JN
authors: Katz
authors: Christian
authors: C
authors: Arbelaez
authors: Laurel A
authors: LA
authors: Donnell-Fink
authors: Rochelle P
authors: RP
authors: Walensky
mesh_terms: D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000368:Aged; D001900:Boston; D004522:Educational Status; D004636:Emergency Service, Hospital; D005260:Female; D005455:Fluorescent Antibody Technique; D006678:HIV; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis* / Q000208:ethnology / Q000523:psychology*; D006679:HIV Seropositivity / Q000097:blood / Q000175:diagnosis* / Q000208:ethnology / Q000523:psychology*; D006630:Hispanic or Latino; D006801:Humans; D007182:Income; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D045808:Refusal to Participate / Q000208:ethnology / Q000523:psychology*; D012737:Sex Factors; D044465:White People