title: Opt-out screening strategy for HIV infection among patients attending emergency departments: systematic review and meta-analysis.
abstract: International health agencies have promoted nontargeted universal (opt-out) HIV screening tests in different settings, including emergency departments (EDs). We performed a systematic review and meta-analysis to assess the testing uptake of strategies (opt-in targeted, opt-in nontargeted and opt-out) to detect new cases of HIV infection in EDs.
  
  
  
  We searched the Pubmed and Embase databases, from 1984 to April 2015, for opt-in and opt-out HIV diagnostic strategies used in EDs. Randomized controlled or quasi experimental studies were included. We assessed the percentage of positive individuals tested for HIV infection in each programme (opt-in and opt-out strategies). The mean percentage was estimated by combining studies in a random-effect meta-analysis. The percentages of individuals tested in the programmes were compared in a random-effect meta-regression model. Data were analysed using stata version 12. Quality assessments were performed using the Newcastle-Ottawa Scale.
  
  
  
  Of the 90 papers identified, 28 were eligible for inclusion. Eight trials used opt-out, 18 trials used opt-in, and two trials used both to detect new cases of HIV infection. The test was accepted and taken by 75 155 of 172 237 patients (44%) in the opt-out strategy, and 73 581 of 382 992 patients (19%) in the opt-in strategy. The prevalence of HIV infection detected by the opt-out strategy was 0.40% (373 cases), that detected by the opt-in nontargeted strategy was 0.52% (419 cases), and that detected by the opt-in targeted strategy was 1.06% (52 cases).
  
  
  
  In this meta-analysis, the testing uptake of the opt-out strategy was not different from that of the opt-in strategy to detect new cases of HIV infection in EDs.
authors.affiliation: Infectious Diseases Department, Internal Medicine Unit, Hospital Universitario Fundacion Alcorcon, Madrid, Spain.
authors.forename: C
authors.identifier: 0000-0002-6714-5840
authors.initials: C
authors.lastname: Henriquez-Camacho
authors.affiliation: Hemato-oncology Unit. Hospital Universitario Principe de Asturias, Alcala de Henares, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Villafuerte-Gutierrez
authors.affiliation: National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Pérez-Molina
authors.affiliation: Infectious Diseases Department, Internal Medicine Unit, Hospital Universitario Fundacion Alcorcon, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Losa
authors.affiliation: Alexander von Humboldt Tropical Medicine Institute, Lima, Peru.
authors.forename: E
authors.initials: E
authors.lastname: Gotuzzo
authors.affiliation: Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
authors.forename: N
authors.initials: N
authors.lastname: Cheyne
mesh_terms: D004636:Emergency Service, Hospital; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D010342:Patient Acceptance of Health Care; D016032:Randomized Controlled Trials as Topic
keywords: 
  HIV
  ; diagnosis; emergency departments; opt-in; opt-out; screening