Patient perspectives on opt-out HIV screening in a Guyanese emergency department

In 2007, the WHO recommended that healthcare providers in areas of a generalised HIV epidemic perform HIV testing on all adults and adolescents presenting for healthcare. Studies regarding patient acceptability of opt-out testing, however, have reported wide variation in acceptance rates. This study examines patient-reported acceptability of such testing at the emergency department (ED) of Georgetown Public Hospital Corporation, the largest public hospital in Guyana. In June 2010, a convenience sample of 343 non-critical adult patients who presented to the ED were interviewed regarding potential acceptance of opt-out HIV testing, with 75.5% (95% CI 70.5-80.0%) stating they would accept testing should it be implemented in the ED. Of 12 patient characteristics, 3 had significant differences in acceptance rates on multivariate analysis: age; gender; and previous HIV testing. In this study, potential reasons for declining testing were also examined. The highest percentage of patient agreement was with the statements 'I have had an HIV test recently enough' (84%, 95% CI 74.0-91.4%) and 'I am not at risk for HIV/AIDS' (83%, 95% CI 73.0-90.4%). The results of this study indicate that the majority of patients in this setting would accept opt-out HIV testing, although some still had concerns regarding testing. Opt-out testing in the ED has the potential to facilitate national goals for increased testing and diagnosis.