Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Natl Med Assoc. 2024 Aug;116(4):351-361. doi: 10.1016/j.jnma.2024.07.009. Epub 2024 Jul 29.
Universal "opt-out" human immunodeficiency virus (HIV) or hepatitis C virus (HCV) testing involves testing individuals for HIV or HCV regardless of symptoms, unless they decline. Little is known about the characteristics of individuals who decline.
We conducted a retrospective, medical record review of adults evaluated at an outpatient clinic in South Carolina. "Opt-out" HIV/HCV testing was implemented in Feb 2019; we reviewed medical records of individuals evaluated in May - July 2019. We excluded individuals who did not meet age-based screening criteria (HIV: 18-65 years; HCV: 18-74 years), had a prior HIV/HCV diagnosis, were tested for HIV/HCV within the preceding 12 months, and whose "opt-out" decision was not documented. We used multivariable logistic regression to estimate adjusted odds ratios (aOR) and 95 % confidence intervals (CI) for "opt-out" decision, with age, sex, race/ethnicity, insurance status, visit type, and genitourinary vs. non-genitourinary chief complaints as predictors.
The final analyses included 706 individuals for HIV and 818 for HCV. Most individuals were non-Hispanic Black (77 % and 78 %) and female (66 % and 64 %). The mean ages were 49.1 (±11.9) and 51.9 (±13.2). Nearly one-third of individuals declined HIV and HCV testing (31 % and 30 %). Black males were more likely to decline HIV and HCV testing than Black females (aOR = 1.61 [95 % CI. 1.08 - 2.40] and aOR = 1.50 [95 %CI. 1.04 - 2.16]).
Despite HIV/HCV testing being the standard of care, approximately one-third of eligible individuals may decline testing, the demographic characteristics of whom may overlap with individuals who are traditionally unaware of their status.
Despite HIV/HCV testing being the standard of care, approximately one-third of eligible individuals may decline testing, the demographic characteristics of whom may overlap with individuals who are traditionally unaware of their status.
普遍的“选择退出”艾滋病毒（HIV）或丙型肝炎病毒（HCV）检测涉及对个体进行 HIV 或 HCV 检测，无论其症状如何，除非他们拒绝。对于拒绝的个体的特征知之甚少。
我们对南卡罗来纳州一家门诊诊所评估的成年人进行了回顾性病历审查。2019 年 2 月实施了“选择退出”HIV/HCV 检测；我们审查了 2019 年 5 月至 7 月期间评估的个体的病历。我们排除了不符合年龄筛查标准的个体（HIV：18-65 岁；HCV：18-74 岁），有 HIV/HCV 诊断史，在过去 12 个月内接受过 HIV/HCV 检测，并且其“选择退出”决定未记录。我们使用多变量逻辑回归估计调整后的优势比（aOR）和 95%置信区间（CI），年龄、性别、种族/民族、保险状况、就诊类型、生殖泌尿系统与非生殖泌尿系统主要投诉作为预测因素。
最终分析包括 706 名 HIV 患者和 818 名 HCV 患者。大多数个体是非西班牙裔黑人（77%和 78%）和女性（66%和 64%）。平均年龄分别为 49.1（±11.9）和 51.9（±13.2）。近三分之一的个体拒绝 HIV 和 HCV 检测（31%和 30%）。黑人男性比黑人女性更有可能拒绝 HIV 和 HCV 检测（aOR=1.61[95%CI.1.08-2.40]和 aOR=1.50[95%CI.1.04-2.16]）。
尽管 HIV/HCV 检测是标准护理，但大约三分之一的符合条件的个体可能会拒绝检测，其人口统计学特征可能与传统上不知道自己状况的个体重叠。
尽管 HIV/HCV 检测是标准护理，但大约三分之一的符合条件的个体可能会拒绝检测，其人口统计学特征可能与传统上不知道自己状况的个体重叠。
