Background: Oral rapid HIV testing has been reported to have a lower sensitivity and specificity than rapid HIV testing with whole-blood and has been associated with clusters of false positive results. Patient preference for oral rapid HIV testing compared to more invasive whole-blood fingerstick may influence the acceptance of rapid HIV testing.
Objective: To compare HIV test acceptance rates among patients routinely offered fingerstick compared to those routinely offered oral fluid screening in an urban hospital emergency department (ED).
Methods: USHER-Phase II was a single-center, prospective, randomized controlled trial that randomized subjects to either fingerstick or oral rapid HIV screening in an urban academic ED. From May 5, 2009 to January 4, 2010, eligible patients aged 18 to 75 years were invited to participate in the trial. The primary outcome measure was HIV test acceptance rate.
Results: 2,012 eligible patients were approached, of whom 1,651 (82%) consented to trial participation and enrolled. Among those enrolled 830 and 821 were randomized to the fingerstick and oral fluid arms, respectively. Acceptance of rapid HIV testing was similar in both arms; 67% (553/830) of subjects accepted fingerstick testing compared to 69% (565/821) who accepted oral (p=0.34).
Conclusions: Although fingerstick rapid HIV testing is more invasive than oral fluid testing, test acceptance rates did not differ. Given the option, preference should therefore be given to fingerstick testing because of its slightly superior test characteristics. System factors such as ease of staff use, necessary CLIA waivers, laboratory capacity, and HIV prevalence should also be considered.
(C) 2014 by Lippincott Williams & Wilkins