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Understanding HIV positive patients' perspective on opt-out, incentivized, & mandatory HIV testing
Thesis

Understanding HIV positive patients' perspective on opt-out, incentivized, & mandatory HIV testing

Sirena Sun
Master of Public Health (M.P.H.), Drexel University
May 2009
DOI:
https://doi.org/10.17918/etd-3102
pdf
Sun_Sirena_20091.08 MB
PDF Access upon request, Email title, URL, or DOI to archives@drexel.edu

Abstract

HIV Patients HIV Testing Public Health
Background: In the absence of a successful HIV vaccine, widespread HIV testing remains the best preventive action against further spread of the HIV epidemic. However, over 40% of the U.S. population has never been tested for HIV. To increase testing rates, in 2006 the CDC advised healthcare settings to conduct testing on an opt-out basis. Objective: Qualitative, semi-structured interviews were conducted to address the lack of studies investigating patients' acceptance of and attitude towards this and more novel testing models, e.g. incentivized or anonymous mandatory testing. Methods: Ten HIV-positive patients aged 18-64 were interviewed. Participants were asked about their HIV testing history and attitudes towards opt-out, incentivized, and mandatory anonymous HIV testing. Other ways to improve U.S. HIV testing rates were also explored. Major themes were identified using grounded theory data analysis. Results: All participants were receptive to opt-out testing, and saw the removal of separate written consent as beneficial as long as patients were given the opportunity to consent in some form. Participants still preferred providing counseling either before or after the test as a form of support. Participants were supportive of incentivized testing as a pragmatic measure to entice people to test, but felt that ideally these coercive measures shouldn't be needed to encourage individuals to look after their own health. Participants were supportive of mandatory testing with consideration for confidentiality of test results. Ultimately, both mandatory and opt-out testing were equally indicated by participants as being the most effective testing model at increasing testing rates. Some participants wanted testing to be mandatory but did not feel that it was a feasible testing initiative because it would never be implemented due to overwhelming resistance. Conclusion: A firm understanding of patients' perspectives allows for development of effective HIV testing initiatives that are patient-sensitive and can substantially reduce HIV infection rates. Future testing initiatives must also be coupled with sufficient linkage to care and campaigns to increase awareness about the importance of HIV testing.

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