Risk, reasons for refusal, and impact of counseling on consent among ED patients declining HIV screening

• Published in: The American journal of emergency medicine 2011-05, Vol.29 (4), p.367-372
• Main Authors: Ubhayakar, Nitin D, Lindsell, Christopher J., PhD, Raab, Dana L., RN, Ruffner, Andrew H, Trott, Alexander T., MD, Fichtenbaum, Carl J., MD, Lyons, Michael S., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; AIDS Serodiagnosis; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Case-Control Studies; Cohort Studies; Consent; Counseling; Decision Making; Directive Counseling; Emergency; Emergency medical care; Emergency Service, Hospital; Female; Health care access; Health risks; HIV; HIV Infections - diagnosis; HIV Infections - psychology; Human immunodeficiency virus; Humans; Imprisonment; Informed Consent - psychology; Institutionalization; Intensive care medicine; Male; Mass Screening; Medical sciences; Medical tests; Middle Aged; Patient Acceptance of Health Care - psychology; Patients; Prevention; Risk assessment; Risk Factors; Risk taking; Socioeconomic Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Young Adult
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2009.10.005

Abstract Screening for HIV in the emergency department (ED) is recommended by the Centers for Disease Control and Prevention. The relative importance of efforts to increase consent among those who currently decline screening is not well understood. We compared the risk characteristics reported by patients who decline risk-targeted, opt-in ED screening with those who consent. We secondarily recorded reasons for declining testing and reversal of the decision to decline testing after prevention counseling. Of 199 eligible patients, 106 consented to testing and 93 declined. Of those declining, 60 (64.5%) of 93 completed a risk assessment. There were no differences in HIV risk behaviors between groups. Declining patients reported recent testing in 73.3% of cases. After prevention counseling, 4 (6.7%) of 60 who initially declined asked to be tested. Given similarities between those who decline and those who consent to testing, efforts to increase consent may be beneficial. However, this should be tempered by the finding that many declined because of a recent negative test. Emphasizing risk during prevention counseling is not a promising strategy for improving opt-in consent rates.