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Dissertation/Thesis Abstract

Evaluation of Opt-Out HIV Screening in Family Planning Sites
by Colantonio, Sophia, M.P.H., Yale University, 2012, 26; 1548082
Abstract (Summary)

Background: In September 2006, the Centres for Disease Control and Prevention (CDC) recommended changing to opt-out screening of HIV for all patients in all health-care settings and for all pregnant women as part of the routine panel of prenatal screening. In opt-out HIV testing, a health care provider verbally informs the patient that the test will be performed and consent is assumed unless they refuse. Earlier opt-in HIV testing guidelines required informed written consent and was targeted at high-risk populations. The objective of this study was to evaluate the impact of opt-out HIV screening in family planning centres.

Methods: In 2011, data were collected in a pre-post survey design study conducted at 6 Planned Parenthood of Southern New England (PPSNE) clinical centres in Connecticut. The pre-test period used opt-in HIV screening and the post-test period used opt-out HIV screening. Differences in participant characteristics and HIV testing rates, satisfaction, and perceptions of HIV testing were compared between the pre (n=250) and post periods (n=250). Patient characteristics examined were gender, age, race, language, income, family size, insurance status, previous HIV and STD testing at Planned Parenthood.

Results: The mean age of patients offered HIV screening was 26 years old, 58% were white, 26% were black, 12% were Hispanic, and 3.2% were other races. Three-quarters of participants were female. Characteristics of patients receiving opt-in and opt-out screening did not significantly differ for all variables except income (p>0.05 for all except income). HIV testing rates (74% and 75%, respectively) and satisfaction with HIV testing (75% and 77%) were similar between both opt-in and opt-out groups (p>0.05 for both). However, patients receiving opt-in versus opt-out screening differed significantly with respect to their opinions of HIV opt-out screening (93% vs. 98% agreed that HIV screening should be routine for the general population). Patients accepting versus refusing opt-out HIV testing in the post-period differed significantly based on gender, testing centre, and reason for visit (p<0.05 for all). Those accepting opt-out testing were more likely to be male, tested in Hartford North, and seeking care for an asymptomatic STD test. At an alpha level of 0.05, both the full and reduced multivariate logistic regression models revealed that individuals who were tested in Danielson were less likely to accept opt-out HIV testing (as compared to reference categories). Hispanics and individuals seeking care for asymptomatic STD visits were more likely to accept opt-out HIV testing (as compared to reference categories).

Conclusion: In family planning centres, opt-in and opt-out HIV screening have similar outcomes in patients' characteristics, HIV testing rates and satisfaction. Testing rates were high in the pre-test period, which may have resulted in a ceiling effect on the HIV testing rates in the post-test period. Opt-out testing was less effective for some groups and further studies should be conducted to understand this phenomenon.

Indexing (document details)
Advisor: Niccolai, Linda M.
Commitee: Pettigrew, Melinda M.
School: Yale University
Department: Public Health
School Location: United States -- Connecticut
Source: MAI 52/03M(E), Masters Abstracts International
Subjects: Public health, Epidemiology
Keywords: Family planning, HIV, HIV screening, Microbial diseases
Publication Number: 1548082
ISBN: 978-1-303-52487-5
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