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Effects of Written Informed Consent Requirements on HIV Testing Rates: Evidence From a Natural Experiment

August 24, 2009

To assess whether written informed consent requirements create barriers that discourage HIV testing, the study author evaluated their effect on HIV testing rates in New York state.

On June 1, 2005, New York streamlined its HIV testing consent procedures. If written informed consent creates barriers to testing, then the state's policy change should have reduced such barriers and increased HIV testing rates. Logistic regression was employed to estimate the effects of the streamlining exercise.

New York's policy change led to a 31.4 percent increase (95 percent confidence interval [CI]=20.9 percent, 41.9 percent) in the state's HIV testing rate. In absolute terms, 7 percent of people in the state had been tested for HIV in the preceding six months under the streamlined procedures, whereas just 5.3 percent would have undergone screening under the original requirements. These estimates indicate that the policy change accounted for roughly 328,000 additional HIV tests in the six months after consent procedures were streamlined.

"Written informed consent requirements are a substantial barrier to HIV testing in the United States. There may be a trade-off between efforts to increase HIV testing rates and efforts to improve patient awareness," the author concluded.

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Excerpted from:
American Journal of Public Health
06.2009; Vol. 99; No. 6: P. 1087-1092; Coady Wing, MA, BPAPM

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