Mandatory Reporting of HIV Infection and Opt-Out Prenatal Screening for HIV Infection: Effect on Testing Rates
April 8, 2003
Reporting of HIV infection to facilitate appropriate follow-up for infected people, to counsel them about their infectiousness to others, and to identify partners who may be unaware of their exposure is now widely recommended. However, there is concern that such disclosure policies may deter people from seeking HIV testing. At the same time, it was recognized that a mandatory reporting system could ensure better tracking of a serious medical problem and provide more accurate HIV statistics at a local level for program planning and distribution of funds.Adapted from:
As in other jurisdictions across Canada, prenatal testing for HIV infection had been performed inconsistently in Alberta, with the result that children continued to be born to HIV-infected women who had not received prophylactic treatment to prevent vertical transmission. Therefore, on Sept. 1, 1998, Alberta adopted an opt-out strategy for prenatal testing for HIV infection. Under this policy, HIV testing is done routinely for all pregnant women seeking prenatal care unless they specifically choose not to be tested.
In this study, the authors evaluated the effect of mandatory reporting of HIV infection and routine screening for prenatal HIV infection on requests for HIV testing in Alberta. The authors obtained data from the Provincial Laboratory for Public Health on the number of males and females in Alberta who were tested for HIV infection between Jan. 1, 1993, and Dec. 31, 2000. They obtained the number of females screened for HIV infection between Sept. 1, 1998, and Dec. 31, 2000, under the opt-out prenatal HIV screening program from the Canadian Blood Services laboratories, and the number of confirmed positive test results from the Provincial Laboratory for Public Health. The authors calculated average annual percent increases in the number of HIV tests performed before and after mandatory reporting was instituted.
Mandatory reporting of HIV infection remains a controversial issue largely owing to concerns about personal and social problems related to breaches in confidentiality. This study shows a clear trend toward increased HIV testing in Alberta despite the introduction of mandatory reporting of HIV infection to public health authorities. These results are consistent with other studies showing that reporting of HIV infection does not provide a distinct disincentive to testing. The authors also found a dramatic and sustained increase in rates of prenatal HIV testing after the opt-out policy was introduced.
The finding of an increased rate of positive test results among pregnant women between 1999 and 2000 is cause for concern, the authors said. The increase may have been due to a real change in incidence among women or a result of better coverage of women at higher risk of HIV infection. The lack of information on the laboratory test requisition forms relating to exposure categories and associated risk factors made it difficult to determine the effect of the opt-out policy on coverage of people at high risk.
The finding that mandatory reporting of HIV infection has not adversely affected the number of HIV tests done in the province is reassuring. It is unclear, however, whether reporting has had a differential effect by deterring people who may be at higher risk of HIV infection, such as men who have sex with men, injection drug users and recent immigrants to Canada, from undergoing testing and seeking treatment and prevention services. Continued monitoring and evaluation are required to ensure that surveillance policies do not adversely affect HIV testing.
Canadian Medical Association Journal
03.18.03; Vol. 168; No. 6: P. 679-682; Gayatri C. Jayaraman; Jutta K. Preiksaitis; Bryce Larke
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