Higher HIV testing rates with opt-out approach

Informing patients that they will receive an HIV test and giving them the option to decline it, yields a significantly higher HIV testing rate than simply informing them that testing is available, according to new research published in the BMJ last week.

A randomised clinical trial of 4,800 patients accessing emergency services in the USA looked at the acceptability of HIV testing using three approaches: opt-in (patients are told that HIV testing is available, but are not explicitly asked to test), active choice (patients are directly asked if they would like to be tested), and opt-out (patients are told that they will be tested, but can decline it).

The research found that 31.8% of people accepted an HIV test in the opt-in arm, 51.3% in the active choice arm, and 65.9% in the opt-out arm. Across all groups, the likelihood of HIV testing uptake was higher if their risk of HIV transmission was described as medium or high.

“Our study provides evidence that small changes in wording can significantly affect patients’ behaviour and thus our understanding of their preferences,” wrote Juan Carlos C. Montoy, MD, from the University of California, and colleagues.

The USA revised its testing guidelines in 2006, calling for routine, non-targeted opt-out testing. But it has been acknowledged that most hospitals have not yet implemented the changes.

The study is one of the largest to look at HIV testing consent options, and the first randomised trial focusing on the acceptability of different HIV testing options. Jason S. Haukoos. MD, and Sarah E. Rowan of the University of Colorado said in an accompanying editorial: “Their results support the notion that ‘the ask’ is a critical piece of the equation and is probably as important as ‘the test’.”