The introduction of routine HIV screening, which requires patients to opt-out, rather than specifically opt-into HIV testing, is acceptable to patients and substantially increases the uptake of HIV testing – at least in a rural area of northern England, according to a study in the May 31st edition of the British Medical Journal.
Doctors at a sexual health clinic in northern Cumbria were concerned that only 35% of patients accessing their services were requesting an HIV test. This is well below the 40% target for 2004, and the 60% target for 2007 set by the UK National Sexual Health and HIV Strategy.
The study involved 200 new patients. They were provided with a leaflet explaining the tests offered as part of a sexual health screen - including tests for HIV and hepatitis B and C. This information was repeat by the doctor in their consultation, after which patients were asked if there were any tests they would like to opt-out from.
HIV testing increased from 35% to 65%. Although this did not lead to the detection of a single new case of HIV, two new cases of hepatitis C were diagnosed, both in patients who had not previously told clinic staff of past injecting drug use.
The investigators comment that “introducing ‘routine’ serological testing increased the acceptability and uptake of HIV screening.” They note that many patients mistakenly already believe that HIV tests are already routinely conducted at sexual health clinics and that clinic staff may incorrectly under-estimate the HIV risk of some of their patients.
In conclusion, they emphasise that their study was conducted in a rural area and that it would be “unwise to extrapolate the results…and expect similar outcomes in urban areas with higher prevalence of HIV, but introducing ‘routine’ screening for HIV and hepatitis in genitourinary medicine was clearly acceptable and significantly increased uptake.”
Further information on this website
Stanley B et al. Uptake of screening in genitourinary medicine after change to “opt-out” consentBMJ 326: 1174.