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.
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