Abstract

THPE135 - Poster Exhibition

Acceptability of HIV screening and trends in the prevalence of newly diagnosed HIV in the opt-out screening era, 2007-2011

R. Setse, A. Mbulaiteye, M. Maneno, K. Lebeta, C. Shamil, R. Mandlewala, A. Abdulahe, M. Ferguson, S. Coleman, C. Maxwell

Howard University Health Sciences, Women's Health Institute, Washington, United States

Background: Following Centers for Disease Control and Prevention (CDC) recommendations in 2006, Opt-Out HIV screening was launched at the Howard University Hospital (HUH) in Washington, DC. Our goals were to examine trends in the prevalence of newly diagnosed HIV/AIDS cases, acceptability of opt-out testing and identify demographic differences in testing refusal among patients at the HUH Emergency Department (ED) in 2007-2011.
Methods: Confidential free HIV screening was offered to presenting patient's ≥16 years at the HUH ED from 2007-2011. Persons who declined testing were permitted to opt-out. Oral specimens were collected from participants by trained research personnel and tested using the OraSure OraQuick Advance^® Rapid HIV-1/2 antibody test. Confirmatory Western Blots were conducted on preliminary positive tests. We determined the annual prevalence of newly diagnosed HIV/AIDS cases and refusal/opt-out rates during 2007-2011. Differences in refusal rates by gender and age groups (< 35, 35-54, ≥55years) were examined using bivariate and multivariable generalized linear models.
Results: From 2007-2011, 32,633 persons (aged 16-86 years) were offered HIV screening. The prevalence (±SE) of newly diagnosed cases ranged from 1.64% (±0.31) in 2007 to 0.42% (±0.23) in 2011. Refusal/opt-out rates were highest in 2007 [47.7% (±0.51)]. Opt-out rates were significantly higher among persons aged ≥55 years and 33-54 years versus those < 35 years (p=0.00). In multivariable analysis, ages 33-54years [Prevalence ratio (PR) 1.42, (95% CI 1.36-1.48)] and ≥55years [PR 1.39 (1.31-1.47)] versus < 35years; and female versus male gender [PR 1.07 (1.02-1.11)] were independently associated with testing refusal.
Conclusions: We observed a decline in the prevalence of newly diagnosed HIV/AIDS cases from 2007-2011. Refusal rates were highest in the first year of testing. Person's ≥35years and females were more likely to opt-out. Opt-out HIV testing is feasible and sustainable in urban ED settings. Targeted efforts are needed to encourage testing among older person's and females.