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
    • Including pregnant women; HIV screening should be included in the routine panel of prenatal screening.
  • 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
References
  1. Branson B, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health care settings. MMWR Morb Mortal Wkly Rep 2006;55(RR-14):1-17.