• Jodian Pinkney, Yao Tong, Susanne Hoeppner, Caroline Derrick, Gregg Talente, Rocio Hurtado, Christina Psaros, Bisola O Ojikutu, Laura M Bogart, Helmut Albrecht, Divya Ahuja, and Emily Hyle.
• 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.
• J Natl Med Assoc. 2024 Aug 1; 116 (4): 351361351-361.

BackgroundUniversal "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.MethodsWe 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.ResultsThe 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]).ConclusionDespite 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 PointDespite 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.

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