1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.
2 Center for Research on US Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, USA.
Public Health Rep. 2019 Sep/Oct;134(5):484-492. doi: 10.1177/0033354919860510. Epub 2019 Jul 31.
In the United States, about 15% of persons living with HIV infection do not know they are infected. Opt-out HIV screening aims to normalize HIV testing by performing an HIV test during routine medical care unless the patient declines. The primary objective of this systematic review and meta-analysis was to assess the acceptance of opt-out HIV screening in outpatient settings in the United States.
We searched in PubMed and CINAHL (Cumulative Index to Nursing and Allied Health Literature) for studies published from January 1, 2006, through December 31, 2018, of opt-out HIV screening in outpatient settings. We collected data from selected studies and calculated for each study (1) the percentage of persons who were offered HIV testing, (2) the percentage of persons who accepted the test, and (3) the percentage of new HIV diagnoses among persons tested. We also collected information on the reasons given by patients for opting out. The meta-analysis used a random-effects model to estimate the average percentages of HIV testing offered, HIV testing accepted, and new HIV diagnoses.
We initially identified 6986 studies; the final analysis comprised 14 studies. Among the 8 studies that reported the size of the study population eligible for HIV screening, 71.4% (95% confidence interval [CI], 53.9%-89.0%) of the population was offered an HIV test on an opt-out basis. The test was accepted by 58.7% (95% CI, 47.2%-70.2%) of persons offered the test. Among 9 studies that reported data on new HIV diagnoses, 0.18% (95% CI, 0.08%-0.26%) of the persons tested had a new HIV diagnosis. Patients' most frequently cited reasons for refusal of HIV screening were that they perceived a low risk of having HIV or had previously been tested.
The rates of offering and accepting an HIV test on an opt-out basis could be improved by addressing health system and patient-related factors. Setting a working target for these rates would be useful for measuring the success of opt-out HIV screening programs.
在美国，约 15%的 HIV 感染者不知道自己已感染。选择退出 HIV 筛查旨在通过在常规医疗保健中进行 HIV 检测来使 HIV 检测正常化，除非患者拒绝。本系统评价和荟萃分析的主要目的是评估美国门诊环境中选择退出 HIV 筛查的接受程度。
我们在 PubMed 和 CINAHL（护理和相关健康文献累积索引）中搜索了 2006 年 1 月 1 日至 2018 年 12 月 31 日期间发表的关于门诊环境中选择退出 HIV 筛查的研究。我们从选定的研究中收集数据，并为每项研究计算了以下内容：（1）提供 HIV 检测的人数百分比，（2）接受检测的人数百分比，以及（3）接受检测的人中新增 HIV 诊断的百分比。我们还收集了患者选择退出的原因信息。荟萃分析采用随机效应模型来估计提供 HIV 检测、接受 HIV 检测和新增 HIV 诊断的平均百分比。
我们最初确定了 6986 项研究；最终分析包括 14 项研究。在报告适合 HIV 筛查的研究人群规模的 8 项研究中，71.4%（95%置信区间[CI]，53.9%-89.0%）的人群基于选择退出原则接受了 HIV 检测。接受检测的人中，58.7%（95%CI，47.2%-70.2%）接受了检测。在报告新增 HIV 诊断数据的 9 项研究中，0.18%（95%CI，0.08%-0.26%）的受检者被新诊断为 HIV 阳性。患者拒绝 HIV 筛查的最常见原因是他们认为自己感染 HIV 的风险较低，或者之前已经接受过检测。
通过解决与卫生系统和患者相关的因素，提供和接受选择退出 HIV 检测的比例可以提高。设定这些比例的工作目标对于衡量选择退出 HIV 筛查计划的成功与否将是有用的。
