1491. Evaluating HIV Voluntary Opt-out Screening in a Tertiary Hospital in Singapore
Session: Poster Abstract Session: Global HIV
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • IDWeek Poster.pdf (371.9 kB)
  • Background:

    Early diagnosis of HIV allows for appropriately timed interventions with improved outcomes. HIV continues to be diagnosed at a late stage in Singapore and uptake of screening is low. We evaluated outcomes of voluntary opt-out screening (VOS) and surveyed reasons for its low uptake in our institution.


    We conducted a prospective observational study (August 2012 - January 2013) assessing outcomes of the VOS programme at the National University Hospital, a 1000-bed tertiary hospital in Singapore. All inpatients ≥ 21 years were eligible for VOS unless the following exclusion criteria were met: unable to opt-out due to mental incapacity or language barriers, or screened for HIV within the past 1 year. We examined the reasons for opting-in and opting-out using an interviewer-administered structured questionnaire in a representative sample during the last month of the study. 


    1675 patients fulfilled VOS criteria and were offered HIV screening. Only 34 (2.0%) opted-in to this screening and none tested HIV-positive. 238 patients (14.2%) were surveyed regarding reasons for opting-in or out of VOS. Of these, 21 (8.8%) had opted-in and the majority were male (76.2%). Patients who opted-in were more likely to be younger (p for trend = 0.026), more educated (p for trend = 0.008) and reported having more regular sexual partners (p for trend = 0.01). Type of housing, number of casual sexual partners, sexual orientation, intravenous drug use, condom use and previous sexually transmitted disease were not associated with opting-in or out of VOS. The most common reasons cited by patients for opting-out were: belief that they were at low risk of HIV (50.2%), being too old (26.8%), cost (6.9%) and aversion to venepuncture (6.5%). The most common reason for opting-in was desire to know their HIV status (47.6%).


    Our study showed that the majority of eligible VOS patients opted-out of HIV screening. Moreover, no case was detected via VOS. Given the considerable cost and relatively low yield of this programme, a re-evaluation of the programme and screening strategies should be conducted, and the common reasons for opting-out addressed.

    Xin Quan Tan, MBBS1, Indumathi Venkatachalam, MBBS2, Wei-Ping Goh, MBBS3, Diana Goh4, Revathi Sridhar, MBBS, MPH4, Ching Chan Hwang4 and Sophia Archuleta, MD1,5, (1)Division of Infectious Diseases, University Medicine Cluster, National University Hospital Singapore, Singapore, Singapore, (2)Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (3)Division of General Medicine and Therapeutics, Department of Medicine, National University Hospital Singapore, Singapore, Singapore, (4)Dept of Medicine, Infectious Disease - Epidemiology Unit (EPIU), National University Hospital Singapore, Singapore, Singapore, (5)Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore


    X. Q. Tan, None

    I. Venkatachalam, None

    W. P. Goh, None

    D. Goh, None

    R. Sridhar, None

    C. C. Hwang, None

    S. Archuleta, None

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