The Ethics of Opt-Out Provider-Initiated HIV Testing in the Emergency Department

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DESCRIPTION (provided by applicant): Dr. Ethan Cowan is an Assistant Professor in the Department of Emergency Medicine at the Albert Einstein College of Medicine. With a background in research on informed consent for clinical procedures, Dr. Cowan is now seeking to develop expertise in empirical research in bioethics. Dr. Cowan is planning to study the intersection of bioethics as it applies to the individual and the health of the public. Emergency Departments (EDs) are a unique environment for this type of research because they provide individual clinical care and serve as a "safety net" for the population by treating the uninsured and underserved making it difficult to separate clinical and public health practice. The proposed study examines the ethical implications of a new public health initiative, opt-out provider-initiated HIV testing (hereby referred to as opt-out testing) in the ED. A mixture of qualitative and quantitative methods will be used to explore ED patients' and providers' beliefs, attitudes and acceptability toward opt-out testing. Ethical aspects of opt-out HIV testing will be examined including, 1) the ability of patients to understand that they have the right to decline the HIV test and that testing will be performed unless they exercise that right, 2) patients' understanding of HIV pretest information prior to undergoing testing, and 3) the impact of language on the understanding of opt-out testing and HIV pretest information. The research will be conducted in the urban ED of the Jacobi Medical Center, serving over 70,000 adult patients annually and staffed by faculty experienced in conducting NIH clinical trials. Dr. Cowan's training plan includes formal coursework, direct mentoring, specialized seminars, and practical experience in project planning and execution. Courses have been selected from the sociomedical sciences curriculum of Columbia University and the ethics program at Union Graduate College. Headed by a world renowned ethicist, Dr. Ruth Macklin, a committee of experts in clinical research methods will serve as mentors for this project. The proposed research has direct impact on public health. The instruments developed in this study may be adapted for use in evaluating and monitoring the ethical aspects of national and international opt-out testing programs. Furthermore, if this study demonstrates that opt-out testing is acceptable and can be ethically implemented this will lend support for adoption of ED based opt-out testing programs on a national scale.