HIV Testing: Data Favor Opt-Out Policy

For HIV testing: opt-out policy → good.

A nationwide policy that would allow a person to opt out of routine HIV testing would prolong thousands of American lives, according to a study presented Saturday by Michael April, a Harvard medical student, at the annual meeting of the Infectious Diseases Society of America (IDSA) in Philadelphia. April estimated that such a policy would save 610,000 life-years,* provided that US infection rates remain stable.

Since 2006, the CDC has recommended routine HIV testing of all adults, adolescents, and pregnant women in healthcare settings—unless the patient declines, or opts out of, testing. Knowledge of an individual's HIV status has important implications for reducing transmission of the virus and prolonging life with medical treatment.

Current policies for opting into or out of HIV testing are dependent on the state. April reported that New York and Florida, for instance, maintain antiquated opt-in policies for HIV testing, in which a person must consent to HIV testing instead of decline routine testing. Both states have comparatively high rates of HIV infection. 

April calculated the rates of HIV diagnosis within opt-in and opt-out states at about 20% and 25%, respectively.** The difference in detection rates amounted to 681,000 undiagnosed HIV infections over time and an average loss of 9.1 months for each infected patient in an opt-in state.

According to the National HIV/AIDS Clinicians' Consultation Center, the following 18 states have opt-out policies for HIV testing or regulations that are compatible or consistent with those of the CDC, as of January 2009. However, in many cases, explicit provisions for HIV testing were not found, or the wording of the policy synopsis is confusing (eg, "Consent is required; oral or written not specified but must be documented. Opt-out process implied. Compatible with CDC Recommendations.").

Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Hawaii
Illinois
Iowa
Kentucky
Louisiana
Maine
Mississippi
New Hampshire
North Carolina
Ohio
Rhode Island
Virginia

The Kaiser Family Foundation (KFF) indicates that 22 states have opt-out policies for the HIV testing of pregnant women.

AIDS = acquired immune deficiency syndrome; HIV = human immunodeficiency virus; opt-out testing = patient consent is inferred, unless patient declines; opt-in testing: patient must explicity consent to testing, often in writing.

N.B.--In the United States, HIV testing is mandatory for blood or organ donors; military personnel and applicants; prison inmates (in certain circumstances); newborns (in some states); and immigrants.

* The abstract reports 549,437 life-years saved.

** An estimated 21% of all HIV-infected Americans are unaware of their infection.

HT: MedPage Today.

Additional sources: April MD et al. The survival cost of opt-in consent for HIV testing. IDSA 2009. Abstract 1254; KFF.

Image of MiraCare Rapid HIV Antibody Test, one FDA-approved laboratory test.