Opt-Out Screening

Routine Screening Should Be Implemented Using an “Opt-Out” Approach

When an Opt-Out approach is implemented, patients should be informed (e.g., through a patient brochure, practice literature/form, or discussion) that an HIV test will be included in the standard preventive screening tests, and that they may decline the test (opt-out screening).¹ A patient’s decision to decline testing should be noted in their medical record. HIV prevention counseling should not be a requirement for HIV testing.

• Risk assessment should be included as part of routine primary care visits for all sexually active patients.
• Individuals at high risk may need to be screened more frequently.
• Prevention counseling also may be needed for patients at high risk for acquiring HIV but should not be required for general testing.

Why Routine, Opt-Out HIV Screening¹

Conducting risk-based screening may fail to identify persons with HIV

• People <20 years of age
• Women
• Members of minority races/ethnicities
• Nonurban dwellers in low-incidence areas
• Heterosexual men and women who are unaware of their risk of HIV

Many people with HIV are not diagnosed until they have advanced HIV or AIDS

Routine, opt-out screening has proved highly effective

• Removes the stigma associated with HIV testing
• Fosters earlier diagnosis and treatment
• Reduces risk of transmission
• Is cost-effective

Justification for routine HIV screening by health care providers includes the following¹

• Serious health disorder that can be detected before symptoms develop
• Detectable by reliable, inexpensive, acceptable screening tests
• People diagnosed with HIV have years of life to gain if treatment is started early, before symptoms develop
• Screening costs are reasonable in relation to anticipated benefits