Analysis of HIV testing refusal among patients aged less than 21 years in the Pediatric Emergency Department

Abstract

HIV testing in the Pediatric Emergency Department (PED) is a novel concept as adolescents, and young adults, use the PED as point of care or first point of contact with the health care system. Our objective was to study the HIV nontesting data and factors that influenced testing decision among patients receiving care in our PED. We designed a survey that inquired about testing acceptance, reasons for rejection, satisfaction with testing conditions, and understanding of the consequence of HIV test results. We approached 500 patients across all shifts in the PED; for analysis, categorical variables were created using demographic data (race, age, ethnicity, marital status, level of education). Forward conditional binary logistic regression was used to explore the effect of various independent predictors on HIV testing rejection with the strength of association measured with adjusted odds ratio (OR), and their 95% CIs. We conducted model fitting by plotting residuals, Hosmer and Lemeshow test statistic, and area under the curve completed using predicted probabilities. We used SPSS Version 25^™, Microsoft Excel 2016^™ for data preparation and analysis. Of the 500 patients approached, 423 (84.6%) completed the survey, median (interquartile) age of survey participants was 19 (17-20) years, 158 (37.4%) rejected HIV testing, 284 (67.1%) were older than 18 years of age, 200 (47.3%) were males, 154 (36.4%) were white, and 127 (30%) were of Hispanic origin. The most common reason for rejecting HIV was low risk perception declared by 79 (50%) respondents. In multivariate analysis, age <18 years (OR, 3.5; 95% CI, 2.3-5.5, P<0.00) and being Hispanic (OR, 2.5; 95% CI, 1.6-3.8, P<0.00) were significant predictors for respondent nontesting. Hosmer and Lemeshow test was not significant, P=0.42, and area under the curve was 0.67 (95% CI, 0.61-0.76). Respondents, <18 years were more likely to reject HIV testing because of low perception of risk. Program addressing risk perception which emphasizes safe health practices should be developed to reduce HIV transmission.

Keywords: HIV test; adolescent; emergency department; testing refusal.

Figure 1

Model ROC. Abbreviation: ROC, receiver operating characteristic.