JAMA Letters to Editor Respond to Research Letter About Eliminating Written Consent for HIV Tests

The Journal of the American Medical Association on Wednesday published two letters to the editor in response to a research letter in the March 13 issue of the journal that said eliminating written consent requirements for HIV tests might increase testing rates. Nicola Zetola of the University of California-San Francisco's Department of Medicine and colleagues compared HIV testing rates before and after May 2006, when the San Francisco Department of Public Health Medical Care System eliminated its written consent requirement for HIV tests. The researchers found that after the change, monthly HIV testing rates increased from 13.5 HIV tests per 1,000 patient visits in June 2006 to 17.9 tests per 1,000 visits in December 2006. The average number of monthly positive HIV tests increased from 20.6 before the change to 30.6 after the change, according to the researchers. CDC in September 2006 released revised recommendations on HIV testing in the U.S. The recommendations advise that HIV tests become a routine part of medical care for residents ages 13 to 64 and that requirements for written consent and pretest counseling be dropped (Kaiser Daily HIV/AIDS Report, 3/15).

• Enrico Girardi et al.: Increased HIV testing "associated with an administrative policy change may not always lead to an increased identification" of HIV-positive people, Girardi of the National Institute for Infectious Diseases in Rome and colleagues write. They add that changes in HIV testing policies, such as dropping pretest written consent requirements, "should not be viewed as an alternative to the implementation of interventions such as anonymous or same-day testing." Before changes that "could result in removal of potentially important components of testing activities" are implemented, "pilot studies assessing their effectiveness in different contexts should be performed," the authors conclude (Girardi et al., JAMA, 6/13).

• Jeffrey Klausner et al.: "Whether an administrative policy change" in HIV testing policies affects the number of new HIV diagnoses "depends on the risk characteristics of the population that undergoes increased testing and whether or not those administrative changes make it easier for high-risk persons to get tested," Klausner of the San Francisco Department of Public Health and colleagues write. The authors conclude that all health care systems "should consider what changes they can implement to make it easier for persons to learn their HIV infection status and elevate those efforts" (Klausner et al., JAMA, 6/13).

An abstract of Girardi's letter is available online. An abstract of Klausner's letter also is available online.

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