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Comparing Routine HIV and Hepatitis C Virus Screening to Estimate the Effect of Required Consent on HIV Screening
Uriel R Felsen1, Aileen Tlamsa2, Lorlette Moir3
1Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.
Insights
Routine HIV screening is significantly lower than hepatitis C virus (HCV) screening in New York hospitals due to consent requirements. This difference impedes public health goals for HIV testing and prevention.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Health Policy
Background:
- Routine screening for HIV and HCV is recommended for specific populations.
- New York State mandates consent for HIV screening but not for HCV screening.
Purpose of the Study:
- To estimate the impact of New York's consent requirement on HIV screening rates compared to HCV screening.
Main Methods:
- Retrospective study of 11,938 hospitalized patients in Bronx, NY (2015-2016).
- Compared screening proportions for HIV and HCV using electronic health record prompts.
- Utilized generalized estimating equations and meta-analytic averaging for adjusted risk difference.
Main Results:
- Only 38.5% of eligible patients underwent HIV screening, compared to 59.1% for HCV screening.
- An adjusted risk difference of 22.0% (95% CI, 20.6%-23.4%) favored HCV screening over HIV screening.
- The disparity in screening rates persisted after adjusting for patient and admission factors.
Conclusions:
- The consent requirement for HIV screening appears to impede routine HIV testing.
- Differences in public perception of HIV versus HCV may also influence screening rates.
- Policy changes regarding consent could improve progress toward public health goals for HIV screening.
Objectives:
Routine screening for HIV and hepatitis C virus (HCV) among specified age cohorts is recommended. New York State requires consent before screening for HIV but not HCV. We sought to estimate the effect of the consent requirement on screening rates for HIV.
Methods:
We performed a retrospective study of patients hospitalized in 2015-2016 at a tertiary care hospital in the Bronx, New York, during a period when prompts in the electronic health record facilitated screening for HIV and HCV among specified age cohorts. We compared proportions of patients eligible for screening for HIV and/or HCV who underwent screening and used generalized estimating equations and a meta-analytic weighted average to estimate an adjusted risk difference between undergoing HIV screening and undergoing HCV screening.
Results:
Among 11 938 hospitalized patients eligible for HIV and/or HCV screening, 38.5% underwent screening for HIV and 59.1% underwent screening for HCV. The difference in screening rates persisted after adjusting for patient and admission characteristics (adjusted risk difference = 22.0%; 95% CI, 20.6%-23.4%).
Conclusions:
Whereas the requirement for consent was the only difference in the processes of screening for HIV compared with screening for HCV, differences in how the 2 viruses are perceived may also have contributed to the difference in screening rates. Nevertheless, our findings suggest that requiring consent continues to impede progress toward the public health goal of routine HIV screening.
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