Opt-out testing

Studies have shown that where opt-out testing is offered, the number of HIV tests taken immediately increases. An early example, described in the BMJ in 2003,¹ came from the GUM clinic at the North Cumbria Hospital in Carlisle. The clinic performed 154 syphilis tests in August 2001 and 70 ‘opt-in’ HIV tests (i.e. patients had to specifically ask for an HIV test). The clinic changed to ‘opt-out’ consent in September 2001. That month, 148 syphilis tests were performed and 130 HIV tests – an 85% increase.

There were similar experiences in Scotland. At Glasgow’s Sandyford Clinic opt-out testing was introduced at the start of 2004.² Every person coming for an STI screen, whether symptomatic or not, would be offered an HIV test and consent would be taken verbally. Objections to the test would be recorded and patients would be told they had the option to return if they changed their minds. Compared to the previous year, there was a 70% increase in HIV tests being performed from one year to the next.

Data from 2007 found that since opt-out testing has been adopted at all Scottish sexual health clinics and most in England and Wales, the percentage of people who accept an HIV test when they attend for an STI check-up (excluding people already diagnosed with HIV) has increased, with a greater increase in heterosexuals (where the proportion having an HIV test increased from 25% in 1997 to over 90% in 2006) than in gay men (where the proportion has gone up from about 45% in 1997 to 85% in 2006). The absolute number of tests performed went up from 400,000 in 2003 to 660,000 in 2006.³