Opting Out Increases HIV Testing in a Large Sexually Transmitted Infections Outpatient Clinic

The current study examines the effect of an opt-out strategy on HIV testing uptake and identifies factors associated with refusing the test. The study was based in a sexually transmitted infection (STI) clinic in Amsterdam that, in January 2007, replaced provider-initiated testing with opt-out testing. The data that were routinely collected at the clinic were analyzed separately for men who have sex with men (MSM) and for heterosexuals. Factors associated with opting out were identified by logistic regression analysis.

In 2007, 12 percent of MSM and 4 percent of heterosexuals with presumed negative or unknown HIV serostatus declined to be tested for HIV. By year's end, the rate of refusal had gradually declined to 7 percent of MSM and 2 percent of heterosexuals. In 2006, prior to the switch to opt-out testing, 38 percent of MSM and 27 percent of heterosexuals had declined testing.

The proportion of positive test results remained stable among MSM, 3.4 percent in 2007 compared to 3.7 percent in 2006, and among heterosexuals, 0.2 percent in 2007 compared to 0.3 percent in 2006.

Among both populations, factors associated with declining the test were age 30 or older, no previous HIV test, the presence of STI-related complaints and no risky anal/vaginal intercourse. Among MSM, patients warned of STI exposure by sexual partners and those diagnosed with gonorrhea or syphilis refused testing more often. Among heterosexuals, men and non-Dutch visitors refused more often.

"An opt-out strategy increased the uptake of HIV testing," the authors concluded. "A sharp increase in testing preceded a more gradual increase, suggesting time must pass to optimize the new strategy. A small group of visitors, especially MSM, still opt out. Counseling will focus on barriers such as fear and low risk perception among high-risk visitors considering opting out."

Back to other news for August 2009