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Several counselors have refusal rates (consent level C) below 10%.
The share of positives is markedly higher among those who declined post-test counseling (consent level B, 49.6%) compared to those who agreed to testing and post-test counseling (consent level A, 27.5%).
Our consent level was high because we targeted individuals that were already actively participating in the Africa Centre surveillance system.
Following pre-test counseling, patients had the option to participate in the study with the return of HIV test results and post-test counseling (consent level A), to participate in the study without the return of test results or post-test counseling (consent level B), or, to decline testing and counseling altogether (consent level C).
The likelihood of infection as measured by the admission diagnosis is first used as a predictor in logistic regression models with the consent level as the outcome.
This is partly compensated by an increasing share of patients who consented to testing without post-test counseling (consent level B) as the likelihood of infection increased.
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Of those in consent levels A and B, 29.7% tested positive.
The three consent levels are used to mimic refusal bias in serosurveys with different post-test counseling study protocols.
Patients had the choice between three consent levels: testing and post-test counseling (including the return of HIV test results), testing without post-test counseling, and total refusal.
Although we should be aware of possible coercion in some trials in which very high (>90%) consent levels have been achieved, such figures could of course be because of attractive features of the trial.
We found evidence of an interaction between the method of consent and level of deprivation for the proportion of children's parents that consented (p=0.023).
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