Patients' Perceptions of Inpatient “Opt‐Out” Testing For Human Immunodeficiency Virus

1University of California San Diego, San Diego, CA
2University of California San Diego, San Diego, CA

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 115


Risk‐based testing for HIV has been shown to have a limited impact on the rates of screening, and the latest CDC guidelines were expanded to recommend routine, voluntary HIV testing in all health care settings for patients aged 1364 years old. A physician‐driven “opt‐out” policy for HIV screening is in place for hospitalized patients at our urban academic medical center. On admission, patients should be educated regarding the program and advised that they will be tesled for HIV unless they specifically decline. Admitting physicians are then prompted to enter a verbal consent for testing in the admission order set. Patients' level of satisfaction with an opt‐out testing policy may affect their willingness to be tested and thus limit the efficacy of the program. However, patients' experiences with the screening process have not been well studied.


Admitted patients aged 18–64 years were asked if they had been offered an HIV test on admission. If so, they were asked to consent for a survey regarding their experiences with the opt‐out program. Questions covered the following issues: from the physician regarding HIV screening guidelines, confidentiality and comfort with being approached regarding testing, and risk factors for HIV infection. The survey had both a 5‐point Likert scale and yes/no questions. Charts were then reviewed to confirm if HIV testing was ordered on all patients eligible for the survey.


Of 576 eligible patients approached, 65 (11%) reported being offered a test, and 49 patients consented to be surveyed. Mean age was 40 years, 57% were male, and 34% were white, 26% Hispanic, and 20% African American. Most (63%) disagreed with or were neutral about receiving education regarding guidelines and resources available for HIV testing. Seventy‐four percent reported being told that the test results would be confidential. A large majority (96%) felt comfortable being asked by their physician to be tested, Most (60%) agreed that they had enough time to ask their physician questions. On chart review, 17% of patients who reported not being consented for testing actually did have tests ordered by their physician.


Despite the goal of the opt‐out program to routinely test patients for HIV, only a small minority recalled being offered a test. Most patients who were surveyed did not feel that they had been educated regarding testing guidelines and available resources. A significant minority of eligible patients were tested, although they did not recall being consented for testing. A physician‐driven testing program may be limited by physicians' active participation. Consent and education for testing may be better performed by an alternative practitioner. It does appear that patients surveyed were comfortable being screened via an opt‐out testing program in the in patient setting Further study is needed to identify optimal screening protocols for inpatient HIV screening.

Author Disclosure:

J. Quartarolo, none; K. Barger, none.

To cite this abstract:

Quartarolo J, Barger K. Patients' Perceptions of Inpatient “Opt‐Out” Testing For Human Immunodeficiency Virus. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 115. Journal of Hospital Medicine. 2010; 5 (suppl 1). Accessed May 23, 2019.

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