title: Characteristics of patients who accept and decline ED rapid HIV testing.
abstract: OBJECTIVE
  Understanding differences between patients who accept and decline HIV testing is important for developing methods to reduce decliner rates among patients at risk for undiagnosed HIV. The objectives of this study were to determine the rates of acceptance and reasons for declining, and to determine if differences exist in patient or visit characteristics between those who accept and decline testing.
  
  
  METHODS
  This was a retrospective medical record review of all patients offered an emergency department (ED) HIV test from 11/1/11 to 10/31/12. Patient demographic characteristics, health characteristics, and ED visit characteristics were compared to assess differences between those who accept and those who decline testing.
  
  
  RESULTS
  Of 4510 ED patients offered an HIV test, 3470 accepted for an acceptance rate of 77%. The most common reasons for declining were "no perceived risk" and "tested in the last 3 months." Those who accepted testing were more likely to be unmarried, less than age 35, Hispanic or African American, Spanish speaking, foreign born, have no primary care provider, report no pain at triage, have a daytime ED visit, and be discharged from the ED compared to admitted. Sex, employment status, and ED length of stay did not affect whether patients accepted testing.
  
  
  CONCLUSIONS
  Acceptance of ED-based rapid HIV testing is not universal, and there are both patient and visit characteristics consistently associated with declining testing. This detracts from the goal of using the ED to screen a large number of at-risk patients who do not have access to testing elsewhere.
authors.affiliation: Department of Emergency Medicine, Boston University School of Medicine. Electronic address: Elissa.schechter@bmc.org.
authors.forename: Elissa M
authors.initials: EM
authors.lastname: Schechter-Perkins
authors.affiliation: Department of Health Policy and Management, Boston University School of Public Health; Center for Healthcare Organization and Implementation Research, ENRM Veterans Hospital.
authors.forename: Elisa
authors.initials: E
authors.lastname: Koppelman
authors.affiliation: Department of Emergency Medicine, Boston University School of Medicine.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Mitchell
authors.affiliation: Department of Health Policy and Management, Boston University School of Public Health.
authors.forename: Jake R
authors.initials: JR
authors.lastname: Morgan
authors.affiliation: Department of Internal Medicine, Boston University School of Medicine.
authors.forename: Randie
authors.initials: R
authors.lastname: Kutzen
authors.affiliation: Department of Health Policy and Management, Boston University School of Public Health; Center for Healthcare Organization and Implementation Research, ENRM Veterans Hospital; Department of Internal Medicine, Boston University School of Medicine.
authors.forename: Mari-Lynn
authors.initials: ML
authors.lastname: Drainoni
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D055815:Young Adult