摘要：Objectives. We estimated associations between payer status, race/ethnicity, and acceptance of nontargeted opt-out rapid HIV screening in the emergency department (ED). Methods. We analyzed data from a prospective clinical trial between 2007 and 2009 at Denver Health. Patients in the ED were offered free HIV testing. Patient demographics and payer status were collected, and we used multivariable logistic regression to estimate associations with HIV testing acceptance. Results. A total of 31 525 patients made 44 765 unique visits: 40% were White, 37% Hispanic, 14% Black, 1% Asian, and 7% unknown race/ethnicity. Of all visits, 10 237 (23%) agreed to HIV testing; 27% were self-pay, 23% state-sponsored, 18% Medicaid, 13% commercial insurance, 12% Medicare, and 8% another payer source. Compared with commercial insurance patients, self-pay patients (odds ratio [OR] = 1.63; 95% confidence interval [CI] = 1.51, 1.75), state-sponsored patients (OR = 1.64; 95% CI = 1.52, 1.77), and Medicaid patients (OR = 1.24; 95% CI = 1.14, 1.34) had increased odds of accepting testing. Compared with White patients, Black (OR = 1.29; 95% CI = 1.21, 1.38) and Hispanic (OR = 1.17; 95% CI = 1.11, 1.23) patients had increased odds of accepting testing. Conclusions. Many ED patients are uninsured or subsidized through government programs and are more likely to consent to free rapid HIV testing. Despite substantial public health efforts, infection with HIV remains an important cause of preventable death in the United States. 1 It is estimated that 230 000 people remain unaware of their infections in the United States and 56 300 new infections occur each year, most of which are attributable to contact with those who remain unaware of their HIV status. 2–5 In an effort to have a further impact on the epidemiology of HIV infection in the United States, the Centers for Disease Control and Prevention (CDC) published revised recommendations for HIV testing in health care settings in 2006. 6 These recommendations attempted to reduce exceptionalism associated with HIV testing by, in part, advocating the performance of routine (nontargeted) screening with an opt-out consent approach. Unfortunately, at that time, little was known about the effectiveness of this approach in most clinical settings, including emergency departments (EDs). Although our understanding of the impact of performing nontargeted HIV screening in EDs has been improved over the past several years, we still have little understanding of specific individual-level characteristics that may influence the performance of this important preventive intervention. In fact, several studies have reported varying proportions of testing when the testing is performed in an ED environment and have highlighted differences in the proportions of patients who accept HIV testing and those who actually complete testing. 7–10 Perceived risk by the patient and the patient's medical acuity likely contribute to the relatively small proportion of patients who accept HIV testing, and several operational considerations likely prevent many of those who accept testing to actually complete testing. Other considerations that may importantly contribute to patient acceptance of nontargeted HIV screening include the ability to pay, specific demographic characteristics, and socioeconomic status. 11 The primary goal of this study was to estimate associations between payer status, race/ethnicity, and acceptance of nontargeted opt-out rapid HIV screening when performed in the ED. The secondary goal was to estimate associations between payer status, race/ethnicity, and completion of nontargeted opt-out rapid HIV screening in the ED.
