21 January 2016

New approach may increase HIV testing

Researchers found that more people end up being screened for HIV when told they'll be checked unless they choose otherwise.


Telling people they'll be screened for HIV unless they decline to be tested, an approach known as "opt-out" testing, could significantly increase the number of patients who agree to be tested, new research suggests.

Small changes in wording

Other approaches to HIV screening, such as leaving it up to patients to specifically ask to be tested, could have the opposite effect, researchers said.

"Our study provides evidence that small changes in wording can significantly affect patients' behaviour and thus our understanding of their preferences and is crucial to providing patient centred care," wrote study leader Juan Carlos Montoy, from the University of California, San Francisco, and colleagues.

Read: HIV testing guidelines

The study, which involved 4,800 patients seen in the emergency room, is the first randomised controlled trial to evaluate consent for HIV testing. None of the patients involved had ever tested positive for the virus.

The researchers divided the patients into three groups based on different approaches to offering HIV testing. The first group received an "opt-in" approach, which let them know that testing was available but they had to specifically request the test.

The second group received an "active choice" approach and were directly asked if they wanted to be tested for the virus. The third group received the "opt-out" approach.

'Opt-out' approach

These people were tested for HIV unless they specifically asked not to be screened.

Read: Few gay and bisexual teen males go for HIV tests

The study found 38 percent of the patients in the "opt-in" group agreed to be tested for HIV. Meanwhile, 51 percent of those in the "active choice" group and 66 percent in the "opt-out" group accepted the HIV test, the study authors said.

The study results were published in the BMJ.

Although patients may prefer to be asked directly if they want to be tested, the study authors concluded that the "opt-out" approach could increase the number of patients actually tested for the virus. They noted this is particularly true for those at intermediate and high-risk for HIV infection.

Read: Three moves could dramatically decrease HIV transmission

These patients, the study showed, were more likely to accept testing than those in low-risk groups. The effects of the "active choice" approach to testing however, didn't vary by level of risk behaviour.

The researchers concluded that more research is needed to assess the effects of the various approaches to HIV screening.

Around the world, 37 million people are infected with HIV, the virus that causes AIDS. About 46 percent of those infected with the virus remain undiagnosed.

HIV testing is critical to controlling the epidemic. "Opt-out" testing has been endorsed in the United States. Europe is also moving toward this approach to testing, the researchers said.

Read more:

Churches are a good place for HIV testing and treatment in Africa

Campaign results in major boost for Cape Town HIV testing

Bringing HIV testing and prevention to the people

Image: Blood testing from iStock


Ask the Expert

HIV/Aids expert

Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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