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The Prevalence of Undiagnosed HIV Infection in Those Who Decline HIV Screening in an Urban Emergency Department

M Czarnogorski1, J Brown, V Lee

  • 1Division of Infectious Diseases, Department of Medicine, The George Washington University, Washington, DC 20037, USA.

AIDS Research and Treatment
|July 9, 2011
PubMed

Insights

Patients declining HIV testing in emergency departments have a significantly higher prevalence of occult HIV infection. This highlights an urgent need for interventions to increase HIV testing acceptance rates.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Epidemiology

Background:

  • Routine HIV testing is crucial for early detection and management of Human Immunodeficiency Virus (HIV).
  • A significant proportion of patients in emergency departments decline HIV testing, potentially leading to undiagnosed infections.
  • Understanding the prevalence of undiagnosed HIV in this population is vital for public health strategies.

Purpose of the Study:

  • To determine the prevalence of occult HIV infection among patients who decline routine HIV testing in an urban emergency department.
  • To compare the prevalence of undiagnosed HIV in patients who decline versus those who accept HIV testing.

Main Methods:

  • Discarded blood samples from patients declining HIV testing were deidentified and tested for HIV using rapid assays.
  • Prevalence rates were compared between patients who declined and those who accepted routine HIV screening during the same period.
  • Statistical analysis, including relative risk calculation, was performed to assess the significance of the difference.

Main Results:

  • The prevalence of occult HIV infection was 2% (12/600) in patients who declined testing.
  • In comparison, 0.7% (35/4845) of patients who accepted testing were found to be HIV positive.
  • The relative risk of undetected HIV infection was 2.74 times higher in patients who declined testing compared to those who accepted (P = .001).

Conclusions:

  • The rate of occult HIV infection is nearly three times higher in patients who decline routine emergency department HIV testing.
  • These findings underscore the need for interventions to reduce opt-out rates and improve HIV screening uptake.
  • Targeted strategies may be necessary to reach individuals who decline routine testing and ensure timely diagnosis and care.

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