Association Between Rates of HIV Testing and Elimination of Written Consents in San Francisco

In May 2006, the San Francisco Department of Public Health Medical Care System eliminated the requirement of separate written consent for HIV testing. The policy reflected recent CDC guidelines intending to streamline HIV testing and link those infected to care, but questions remained whether removing separate written consent would boost HIV testing.

HIV antibody testing was added to the routine laboratory requisition form, and by state law clinicians at the acute, long-term, and more than 15 other health care centers had to obtain informed patient consent, which would be documented in the patient's medical chart. The patient's signature was no longer required for HIV testing, however.

HIV testing increased steadily, from 13.5 tests per 1,000 patients in June 2006 to 17.9 tests per 1,000 patients in December 2006. The mean monthly number of HIV tests performed per 1,000 patients in June-December 2006 was 4.5 more than expected, given testing trends from December 2003 to April 2006 (95 percent confidence interval [CI], 3.2-5.8; P<.001). The monthly mean number of HIV-positive test results increased from 20.6 (95 percent CI, 17.3-23.8) before the policy change to 30.6 (95 percent CI, 25.7-35.5) after the change. Compared to before the policy change, when there were a median 16 tests rejected by the lab per month based on incomplete documentation, there were zero such rejections after the policy change (P<.001).

"These findings are consistent with increases in HIV testing associated with an administrative policy change that simplified consent for HIV testing," concluded the authors. "Because these data are observational, other events may have contributed to this temporal increase of HIV testing. The XVI International AIDS Conference in mid-August 2006 and the release of the revised CDC recommendations for HIV testing in September 2006 may have heightened clinician and patient awareness and affected clinicians' testing practices. However, the increase in testing appears to have begun before those events and maintained a steady increase thereafter, so that these events are unlikely to explain the increase in HIV testing. Nevertheless, as an ecological study, these results are hypothesis generating, and further studies are required for confirmation."

Back to other news for October 2007