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Short report
Increasing HIV testing engagement through provision of home HIV self-testing kits for patients who decline testing in the emergency department: a pilot randomisation study
  1. Anuj V Patel1,
  2. Samuel M Abrams1,
  3. Charlotte A Gaydos1,2,
  4. Mary Jett-Goheen2,
  5. Carl A Latkin3,
  6. Richard E Rothman1,2,
  7. Yu-Hsiang Hsieh1
  1. 1Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Medicine, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  3. 3Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Professor Yu-Hsiang Hsieh, Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; yhsieh1{at}


Objective Up to 60% of patients decline routine HIV testing offer in US emergency departments (EDs). The objective of this study is to determine whether the provision of HIV self-testing (HIVST) kit would increase engagement of HIV testing among these HIV test ‘Decliners’.

Methods Patients who declined a test offered in an ED-based triage nurse-driven HIV screening programme were enrolled and randomised to either the HIVST or the control group. The patients in the HIVST group received HIVST kits to take home, were encouraged to report test results to an established internet-based STI/HIV testing recruitment website ‘I Want the Kit’ (IWTK) and received five referral cards for their peers to request HIVST kits from IWTK. The control group received pamphlets about publicly available HIV testing sites. HIV testing from both groups after enrolment was determined via telephone follow-up at 1 month. Testing rate ratio (RR) was determined using χ2 tests.

Results Fifty-two patients were randomised to the HIVST group and 48 to the control group. Among all 64 patients completing any follow-up, 14/29 (48%) patients in the HIVST group tested themselves at home with the provided kit. Four of these had never had an HIV test. Only 2/35 (6%) in the control group reported having an HIV test after enrolment (RR: 8.45 (95% CI: 2.09 to 34.17)). 57% (8/14) in the HIVST group reported test results to IWTK.

Conclusion Provision of HIVST kits supplements ED-based screening programme and significantly improved engagement of HIV testing among those test ‘Decliners’ in the ED.

Trial registration number NCT03021005, results.

  • HIV
  • HIV testing
  • screening
  • behavioural interventions
  • intervention studies
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  • AVP and SMA contributed equally.

  • Handling editor Jackie A Cassell

  • Contributors Y-HH designed the study. SMA, CAG, MJ-G and RER provided critical suggestions to assist Y-HH to finalise the study protocol. SMA, AVP and MJ-G had primary responsibility for the data collection. AVP and SMA conducted the phone follow-up survey. Y-HH performed data analyses. Y-HH, SMA, AVP, CAG and RER primarily interpreted results. Y-HH and AVP primarily drafted the manuscript. SMA, CAG, RER, MJ-G and CAL performed critical editing of the manuscript.

  • Funding CAG, MJ-G, RER and Y-HH are supported by National Institutes of Health (NIH) U54EB007958. CAG is also supported by U01-068613, National Institute of Allergy and Infectious Diseases, NIH.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Johns Hopkins School of Medicine Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at Part of this work was presented at the 2016 Society of Academic Emergency Medicine Midwest Regional Meeting, 8–9 September 2016, Indianapolis, Indiana, USA, and at the 2017 Society of Academic Emergency Medicine Annual Meeting, 16–19 May 2017, Orlando, Florida, USA.

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