***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Early diagnosis of human immunodeficiency virus ( HIV ) allows for appropriately timed interventions with improved outcomes , but HIV screening among asymptomatic persons and the general population in Singapore remains low . In 2008 , Singapore ’s Ministry of Health implemented  HIV voluntary opt-out screening ( VOS ) for hospitalised adults . We evaluated the outcome of VOS and surveyed reasons for its low uptake in our institution . Methods We assessed the outcomes of the VOS programme from January 2010 to December 2013 at National University Hospital , a 1081-bed tertiary hospital in Singapore . We also examined reasons for opting-in and opting-out using an interviewer – administered structured question naire in a representative sample in January 2013 . Results 107,523 patients fulfilled VOS criteria and were offered HIV screening , of which 5215 ( 4.9 % ) agreed to testing . 4850 ( 93.1 % ) of those who opted-in had an HIV test done . Three ( 0.06 % ) tested positive for HIV . 238 patients ( 14.2 % ) were surveyed regarding reasons for opting-in or out of VOS . 21 ( 8.8 % ) had opted-in . Patients who opted-in were likely to be younger , more educated and reported having more regular sexual partners . Type of housing , number of casual sexual partners , sexual orientation , intravenous drug use , condom use and previous sexually transmitted infection were not associated with deciding to opt-in/out . Patients ’ most common reasons for opting-out were : belief that they were at low risk ( 50.2 % ) , belief that they were 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 % ) . Conclusion The success of an HIV-VOS program is largely determined by test uptake . Our study showed that the majority of eligible VOS patients opted-out of  HIV screening . Given the considerable cost and low yield of this programme , more needs to be done to better equip patients in self-risk assessment and opting in to testing OBJECTIVE We compare outcomes of opt-in and opt-out  HIV screening  approaches  in an urban emergency department . METHODS This was a 1-year prospect i ve observational study comparing 2 6-month screening approaches . Eligibility for opt-in and opt-out screening was identical : aged 15 years or older , medically stable , and able to complete general consent . During the opt-in phase , triage nurses referred patients to HIV testers stationed at triage , who obtained separate opt-in written consent and performed rapid oral fluid tests  . During the opt-out phase , registration staff conducted integrated opt-out consent and then referred patients to HIV testers . We assessed the proportion of potentially eligible patients who were offered screening ( screening offer rate ) , the proportion offered screening who accepted ( screening acceptance rate ) , the proportion who accepted screening and subsequently completed testing ( test completion rate ) , and the proportion of potentially eligible patients who completed testing ( overall screening rate ) during each phase . RESULTS For the opt-in versus the opt-out phases , respectively , there were 23,236 potentially eligible patients versus 26,757 ,  screening offer rate was 27.9 % versus 75.8 % ( P<.001 ) , screening acceptance rate was 62.7 % versus 30.9 % ( P<.001 ) , test completion rate was 99.8 % versus 74.6 % ( P<.001 ) , and overall screening rate was 17.4 % versus 17.5 % ( P = .90 ) . CONCLUSION A significantly higher proportion of patients were offered HIV screening  with an opt-out approach at registration . However , this was offset by much higher screening acceptance and test completion rates with the opt-in approach at triage . Overall screening rates with the 2 approaches were nearly identical Background The Centers for Disease Control and Prevention recommends nontargeted opt-out HIV screening in healthcare setting s. Cost effectiveness is critical when considering potential screening methods . Our goal was to compare programmatic costs of nontargeted opt-out rapid HIV screening with physician-directed diagnostic rapid HIV testing in an urban emergency department ( ED ) as part of the Denver ED HIV Opt-Out Trial . Methods This was a prospect i ve cohort study nested in a larger quasi-experiment . Over 16 months , nontargeted rapid HIV screening ( intervention ) and diagnostic rapid HIV testing ( control ) were alternated in 4-month time blocks . During the intervention phase , patients were offered HIV testing using an opt-out approach during registration ; during the control phase , physicians used a diagnostic approach to offer HIV testing to patients . Each method was fully integrated into ED operations . Direct program costs were determined using the perspective of the ED . Time-motion methodology was used to estimate personnel activity costs . Costs per patient newly-diagnosed with HIV infection by intervention phase , and incremental cost effectiveness ratios were calculated . Results During the intervention phase , 28,043 eligible patients were included , 6,933 ( 25 % ) completed testing , and 15 ( 0.2 % , 95 % CI : 0.1%–0.4 % ) were newly-diagnosed with HIV infection . During the control phase , 29,925 eligible patients were included , 243 ( 0.8 % ) completed testing , and 4 ( 1.7 % , 95 % CI : 0.4%–4.2 % ) were newly-diagnosed with HIV infection . Total annualized costs for nontargeted screening were $ 148,997 , whereas total annualized costs for diagnostic HIV testing were $ 31,355 . The average costs per HIV diagnosis were $ 9,932 and $ 7,839 , respectively . Nontargeted HIV screening identified 11 more HIV infections at an incremental cost of $ 10,693 per additional infection . Conclusions Compared to diagnostic testing , nontargeted HIV screening was more costly but identified more HIV infections . More effective and less costly testing strategies may be required to improve the identification of patients with undiagnosed HIV infection in the ED OBJECTIVES The Centers for Disease Control and Prevention recommends routine opt-out HIV screening in health care setting s. Our goal was to evaluate the feasibility and yield of this strategy in the emergency department ( ED ) and to compare it to the expected yield of physician-directed testing . METHODS This is a cross-sectional study in an urban ED during r and om shifts over 1 year . Patients were ineligible for screening if they were younger than 18 years or older than 64 , a prisoner , a victim of sexual assault , in an ED resuscitation room , or had altered mental status . Research associates administered rapid HIV tests and conducted st and ardized interviews . The patients ' ED physician , blinded to the HIV result , was asked if they would have ordered a rapid HIV test if it had been available . RESULTS Of 7756 ED patients , 3957 ( 51 % ) were eligible for HIV screening , and 2811 ( 71 % ) of those did not opt out . Routine testing yielded 9 new HIV cases ( 0.32 % of those tested ; 95 % confidence interval , 0.16%-0.63 % ) . Physician-directed testing would have missed most of these infections : 2 of the 785 patients identified by physicians for testing would have been newly diagnosed with HIV ( 0.25 % ; 95 % confidence interval , 0.04%-1.0 % ) . Of the 9 new HIV cases , 5 established HIV care , and their median CD4 count was 201 cells/μL ( range , 71 - 429 cells/μL ) . CONCLUSIONS Routine opt-out HIV screening was feasible and accepted by a majority of ED patients . The yield of this strategy only modestly exceeded what may have been observed with physician-directed testing STUDY OBJECTIVE A clinical prediction tool , the Denver HIV Risk Score , was recently developed to help identify patients with increased probability of undiagnosed HIV infection . Our goal was to compare targeted rapid HIV screening using the Denver HIV Risk Score to nontargeted rapid HIV screening in an urban emergency department ( ED ) and urgent care . METHODS We used a prospect i ve , before-after design at an urban medical center with an approximate annual census of 110,000 visits . Patients aged 13 years or older were eligible for screening .  Targeted HIV screening of  patients identified as high-risk by nurses using the Denver HIV Risk Score during medical screening was compared to nontargeted HIV screening offered by medical screening nurses during 2 separate 4-month time periods . The primary outcome was newly diagnosed HIV-infected patients . RESULTS 28,506 patients presented during the targeted phase , 1,718 were identified as high-risk , and 551 completed HIV testing . Of these , 7 ( 1.3 % , 95 % confidence interval [ CI ] 0.5 % to 2.6 % ) were newly diagnosed with HIV infection . 29,510 patients presented during the nontargeted phase and 3,591 completed HIV testing . Of these , 7 ( 0.2 % , 95 % CI 0.1 % to 0.4 % ) were newly diagnosed with HIV infection .  Targeted HIV screening was significantly associated with identification of newly diagnosed HIV infection when compared to nontargeted screening , adjusting for patient demographics and payer status ( relative risk [ RR ] 10.4 , 95 % CI 3.4 to 32.0 ) . CONCLUSION Targeted HIV screening using the Denver HIV Risk Score was strongly associated with new HIV diagnoses when compared to nontargeted screening . Although both HIV screening methods identified the same absolute number of newly diagnosed patients , significantly fewer tests were required during the targeted phase to achieve the same effect OBJECTIVES The objective was to evaluate patient acceptance and underst and ing of nontargeted opt-out and opt-in rapid  human immunodeficiency virus  (  HIV ) screening using computerized kiosks in the emergency department ( ED ) . METHODS This study was a prospect i ve quasi-experiment in an urban hospital with an annual ED and urgent care census of 120,000 visits . During medical screening , patients 13 years and older were offered rapid HIV screening using kiosks and opt-out consent ( October 2009 ) or opt-in consent ( December 2009 ) . R and om time blocks were used to administer structured surveys to evaluate patient underst and ing of the testing process . RESULTS During the opt-out phase , 6,602 were offered testing , and of these 3,993 ( 61 % ) did not opt-out and 886 ( 13 % ) completed screening . During the opt-in phase , 5,781 were offered testing , and of these 930 ( 16 % ) opted-in and 389 ( 7 % ) completed screening ( absolute difference = 6 % , 95 % confidence interval [ CI ] = 5 % to 8 % ) . During the opt-out phase , 330 patients completed the survey . Of these , 201 ( 61 % ) did not opt-out , but 108 ( 54 % , 95 % CI = 47 % to 61 % ) responded that they had not been informed about an HIV test . Of the 84 patients who had been informed , 32 ( 38 % , 95 % CI = 28 % to 49 % ) responded that they had not agreed to an HIV test . During the opt-in phase , 416 completed the survey . Of these , 80 ( 19 % ) agreed to testing and two ( 3 % , 95 % CI = 0.3 % to 9 % ) responded that they had not been informed about an HIV test . Of the 74 patients who had been informed , only two ( 3 % , 95 % CI = 0.3 % to 9 % ) responded that they had not agreed to an HIV test . CONCLUSIONS Computerized kiosks can be successfully used to perform nontargeted rapid HIV screening in EDs . However , when using this approach , patient underst and ing of opt-in consent is significantly better than opt-out consent BACKGROUND To lower the number of undiagnosed infections and to improve early detection , international health agencies have promoted nontargeted human immunodeficiency virus ( HIV ) screening in health care setting s , including emergency departments ( EDs ) . This strategy remains controversial and has yet to be tested on a large scale . We assessed the public health impact of nontargeted HIV-rapid test ( RT ) screening among ED patients in the metropolitan area of Paris ( 11.7 million inhabitants ) , where half of France 's new HIV cases are diagnosed annually . METHODS During a r and omly assigned 6-week period for each of the 29 participating EDs , 18- to 64-year-old patients who were able to provide consent for HIV testing were offered a fingerstick whole-blood HIV RT . Main outcome measures were the number of patients tested for HIV and their characteristics vs those of the general metropolitan Paris population and the proportion of newly diagnosed HIV-positive patients among those tested and their characteristics vs those from the national HIV case surveillance . RESULTS Among 138,691 visits , there were 78,411 eligible patients , 20,962 of whom ( 27.0 % ) were offered HIV RT ; 13,229 ( 63. 
    Output:
    
In this meta- analysis , the testing uptake of the opt-out strategy was not different from that of the opt-in strategy to detect new cases of HIV infection in EDs