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      Factors Associated with Refusal of Rapid HIV Testing in an Emergency Department

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          Abstract

          HIV screening studies in the emergency department (ED) have demonstrated rates of HIV test refusal ranging from 40–67%. This study aimed to determine the factors associated with refusal to undergo routine rapid HIV testing in an academic ED in Boston. HIV counselors offered routine testing to 1,959 patients; almost one-third of patients (29%) refused. Data from a self-administered survey were used to determine independent correlates of HIV testing refusal. In multivariate analysis, women and patients with annual household incomes of $50,000 or more were more likely to refuse testing, as were those who reported not engaging in HIV risk behaviors, those previously HIV tested and those who did not perceive a need for testing. Enrollment during morning hours was also associated with an increased risk of refusal. Increased educational efforts to convey the rationale and benefits of universal screening may improve testing uptake among these groups.

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          Development and psychometric evaluation of the brief HIV Knowledge Questionnaire.

          Michael Carey, Kerstin E. E. Schroder (2002)
          This research evaluated the psychometric properties of a brief self-report measure of HIV-related knowledge, the 18-item HIV Knowledge Questionnaire (HIV-KQ-18). Low-income men and women (N = 1,019) responded to 27 items that represented the domain of interest. Item analyses indicated that 18 items, with item-total correlations ranging from .24 to .57, be retained. Additional analyses demonstrated the HIV-KQ-18's internal consistency across samples (alphas = .75-.89), test-retest stability across several intervals (rs = .76- .94), and strong associations with a much longer, previously validated measure (rs = .93-.97). Data from three clinical trials indicated that the HIV-KQ-18 detected knowledge gains in treated participants when compared to untreated controls. We conclude that the HIV-KQ-18 is internally consistent, stable, sensitive to the change resulting from intervention, and suitable for use with low-literacy populations.
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            Emergency department visits for ambulatory care sensitive conditions: insights into preventable hospitalizations.

            Ady Oster, Andrew B. Bindman (2003)
            To explore whether differences in disease prevalence, disease severity, or emergency department (ED) admission thresholds explain why black persons, Medicaid, and uninsured patients have higher hospitalization rates for ambulatory care sensitive (ACS) conditions. The National Hospital Ambulatory Care Survey was used to analyze the ED utilization, disease severity (assessed by triage category), hospitalization rates, and follow-up plans for adults with five chronic ACS conditions (asthma, chronic obstructive lung disease, congestive heart failure, diabetes mellitus, and hypertension). The National Health Interview Survey was used to estimate the prevalence of these conditions in similarly aged US adults. Black persons, Medicaid, and uninsured patients make up a disproportionate share of ED visits for these chronic ACS conditions. Cumulative prevalence of these conditions was higher in black persons (33%) compared with white persons (27%) and Hispanic persons (22%), but did not differ among the payment groups. All race or payment groups were assigned to similar triage categories and similar percentages of their ED visits resulted in hospitalization. Black persons and Hispanic persons (odds ratios for both = 0.7), were less likely than white persons, whereas Medicaid and uninsured patients (odds ratios for both = 0.8), were less likely than private patients to have follow-up with the physician who referred them to the ED. The disproportionate ED utilization for chronic ACS conditions by black persons and Medicaid patients does not appear to be explained by either differences in disease prevalence or disease severity. Follow-up arrangements for black persons, Medicaid, and uninsured patients suggest that they are less likely to have ongoing primary care. Barriers to primary care appear to contribute to the higher ED and hospital utilization rates seen in these groups.
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              HIV prevalence estimates--United States, 2006.

              (2008)
              Accurate and timely data on the number of persons in the United States living with human immunodeficiency virus (HIV) infection (HIV prevalence) are needed to guide planning for disease prevention, program evaluation, and resource allocation. However, overall HIV prevalence cannot be measured directly because a proportion of persons infected with HIV have neither been diagnosed nor reported to local surveillance programs. In addition, national HIV prevalence data are incomplete because local reporting systems for confidential, name-based HIV reporting have been fully implemented only since April 2008. With the advent of highly active antiretroviral therapies that delay the progression of HIV to acquired immunodeficiency syndrome (AIDS), and of AIDS to death, and changes in the AIDS case definition to include an immunologic diagnosis, earlier back-calculation methods from the 1990s for estimating HIV prevalence based on the number of reported AIDS cases are no longer reliable. With 80% of states reporting name-based HIV diagnoses as of January 2006, an extended back-calculation method now can be used to estimate HIV prevalence more accurately. Based on this method, CDC now estimates that 1.1 million adults and adolescents (prevalence rate: 447.8 per 100,000 population) were living with diagnosed or undiagnosed HIV infection in the United States at the end of 2006. The majority of those living with HIV were nonwhite (65.4%), and nearly half (48.1%) were men who have sex with men (MSM). The HIV prevalence rates for blacks (1,715.1 per 100,000) and Hispanics (585.3 per 100,000) were, respectively, 7.6 and 2.6 times the rate for whites (224.3 per 100,000).
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                Author and article information

                Contributors
                : rwalensky@partners.org
                Journal
                Journal ID (nlm-ta): AIDS Behav
                Title: AIDS and Behavior
                Publisher: Springer US (Boston )
                ISSN (Print): 1090-7165
                ISSN (Electronic): 1573-3254
                Publication date (Electronic): 27 October 2010
                Publication date PMC-release: 27 October 2010
                Publication date (Print): May 2011
                Volume: 15
                Issue: 4
                Pages: 734-742
                Affiliations
                [1 ]Division of Infectious Disease, Brigham and Women’s Hospital, Boston, MA USA
                [2 ]Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA USA
                [3 ]Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
                [4 ]Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA USA
                [5 ]Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA USA
                [6 ]Department of Epidemiology, Harvard School of Public Health, Boston, MA USA
                [7 ]Division of Infectious Disease, Massachusetts General Hospital, Boston, MA USA
                [8 ]Center for AIDS Research, Harvard Medical School, Boston, MA USA
                [9 ]Division of Infectious Disease, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114 USA
                Article
                Publisher ID: 9837
                DOI: 10.1007/s10461-010-9837-2
                PMC ID: 3082047
                PubMed ID: 20978834
                SO-VID: 5ad79bd1-96d4-46c5-9ee8-a63f3a8a74a0
                Copyright © © The Author(s) 2010
                History
                Categories
                Subject: Original Paper
                Custom metadata
                issue-copyright-statement © Springer Science+Business Media, LLC 2011

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: emergency department,routine hiv testing,hiv test refusal,rapid hiv testing,human immunodeficiency virus,hiv test acceptance
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: emergency department, routine hiv testing, hiv test refusal, rapid hiv testing, human immunodeficiency virus, hiv test acceptance

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