Background: Optimal methods for implementing HIV screening in health care settings remain unknown.
Objective: To compare the acceptance rates of emergency department HIV screening when supplemental staff use opt-in and opt-out consent methods.
Methods: Experimental equivalent time-sample, conducted in an urban emergency department with an annual census of 80,000 visits. HIV screeners performed nontargeted HIV screening using point-of-care, rapid HIV tests. Eligible patients were medically stable, English or Spanish speaking, ≥13 or ≤64 years, not HIV tested in past 6 months, and not psychiatrically impaired. Screeners offered eligible patients HIV screening using either opt-in or opt-out consent methods on alternate weeks. Main outcome measures were the acceptance rate of HIV screening and the association between opt-out rapid HIV screening and acceptance.
Results: Of the eligible patients, 2409 were offered HIV screening, with 1209 (50%) on opt-in days and 1200 (50%) on opt-out days. The mean age was 40 years, 52% were male, 45% were Black, 28% Hispanic, and 15% white. The acceptance rate of opt-in HIV screening was 63% [767 of 1209, 95% confidence interval (CI): 61% to 66%] and the acceptance rate of opt-out HIV screening was 78% (931 of 1200, 95% CI: 75% to 80%), absolute difference 14% (95% CI: 11% to 18%). The acceptance rate of opt-out HIV screening remained greater after adjusting for patient demographics, admission status, acuity, treatment area, privacy of encounter, and screening staff identity (adjusted odds ratio: 2.0, 95% CI: 1.7 to 2.4).
Conclusions: Opt-out HIV screening using supplemental staff increases patient acceptance and should be considered as the consent methodology of choice.