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
- 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
- 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.