Who declines "opt-out" HIV/HCV testing? Experience of an internal medicine resident continuity clinic serving a predominantly Black adult population in South Carolina.

Autor:	Pinkney J; 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. Electronic address: jpinkney@mgh.harvard.edu., Tong Y; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA., Hoeppner S; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA., Derrick C; Department of Internal Medicine, Prisma Health Midlands/University of South Carolina School of Medicine, Columbia, South Carolina, USA., Talente G; Department of Internal Medicine, Prisma Health Midlands/University of South Carolina School of Medicine, Columbia, South Carolina, USA., Hurtado R; Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA., Psaros C; Harvard Medical School, Boston, Massachusetts, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA., Ojikutu BO; Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Boston Public Health Commission, Boston, Massachusetts, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA., Bogart LM; RAND Corporation, Santa Monica, California, USA., Albrecht H; Department of Internal Medicine, Prisma Health Midlands/University of South Carolina School of Medicine, Columbia, South Carolina, USA., Ahuja D; Department of Internal Medicine, Prisma Health Midlands/University of South Carolina School of Medicine, Columbia, South Carolina, USA., Hyle E; 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. Electronic address: ehyle@mgh.harvard.edu.
Jazyk:	angličtina
Zdroj:	Journal of the National Medical Association [J Natl Med Assoc] 2024 Aug; Vol. 116 (4), pp. 351-361. Date of Electronic Publication: 2024 Jul 29.
DOI:	10.1016/j.jnma.2024.07.009
Abstrakt:	Background: 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. Methods: 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. Results: 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]). Conclusion: 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. Main Point: 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. (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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