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

HIV testing studies in the emergency department have found rates of testing refusal of 40 percent to 67 percent, noted authors of the current study. Walensky and colleagues examined factors associated with refusal to undergo routine rapid HIV testing in an academic ED in Boston.

Of the 1,959 subjects offered HIV testing by an HIV counselor, 577 (29 percent) refused. Data from a self-administered survey were used to determine independent correlates of refusal.

Participants more likely to refuse testing included women, those with annual household incomes of $50,000 or greater, those reporting no HIV risk behaviors, those previously tested, those who did not perceive a need for testing, and participants enrolled during the morning hours.

Adjusting for other factors, a history of prior HIV testing was associated with a 20 percent increase in testing refusal. Perceived risk for HIV may be tied to refusal. Perception of risk may be influenced by nonclinical factors, as the proportion who perceived a need for testing was low (16 percent), and nearly 15 percent who perceived a need nonetheless refused testing. Low self-perceived need for testing was the strongest independent correlate for test refusal, with more than a two-fold increased risk.

As the trial was conducted at one site, it may not be generalizable to other EDs, the authors cautioned. However, "our findings demonstrate that routine HIV screening programs may not fully or equally engage all groups, including women, patients with higher incomes, and participants who did not perceive a need for HIV testing," they concluded. "Increased educational efforts to convey the rationale and benefits of universal screening may improve testing uptake among these groups. In addition, the modification of routine HIV screening programs to offer testing during hours of lower test refusal may increase testing rates."

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