Projected survival gains from revising state laws requiring written opt-in consent for HIV testing

April, Michael D.; Chiosi, John J.; Paltiel, A. David; Sax, Paul E.; Walensky, Rochelle P.
June 2011
JGIM: Journal of General Internal Medicine;Jun2011, Vol. 26 Issue 6, p661
Academic Journal
journal article
Background: Although the Centers for Disease Control and Prevention recommends HIV testing in all settings unless patients refuse (opt-out consent), many state laws require written opt-in consent.Objective: To quantify potential survival gains from passing state laws streamlining HIV testing consent.Design: We retrieved surveillance data to estimate the current annual HIV diagnosis rate in states with laws requiring written opt-in consent (19.3%). Published data informed the effect of removing that requirement on diagnosis rate (48.5% increase). These parameters then served as input for a model-driven projection of survival based on consent method. Other inputs included undiagnosed HIV prevalence (0.101%); and annual HIV incidence (0.023%).Patients: Hypothetical cohort of adults (>13 years) living in written opt-in states.Measurements: Life years gained (LYG).Results: In the base-case, of the 53,036,383 adult persons living in written opt-in states, 0.66% (350,040) will be infected with HIV. Due to earlier diagnosis, revised consent laws yield 1.5 LYG per HIV-infected person, corresponding to 537,399 LYG among this population. Sensitivity analyses demonstrate that diagnosis rate increases of 24.8-72.3% result in 304,765-724,195 LYG. Net survival gains vanish if the proportion of HIV-infected persons refusing all testing in response to revised laws exceeds 18.2%.Conclusions: The potential survival gains of increased testing are substantial, suggesting that state laws requiring opt-in HIV testing should be revised.


Related Articles

  • Low health literacy is associated with HIV test acceptance. Barragán, Maribel; Hicks, Giselle; Williams, Mark V.; Franco-Paredes, Carlos; Duffus, Wayne; del Rio, Carlos; Barragán, Maribel // JGIM: Journal of General Internal Medicine;May2005, Vol. 20 Issue 5, p422 

    Background: The Centers for Disease Control and Prevention has proposed increasing the proportion of people who learn their HIV serostatus. The health care setting represents a logical site to accomplish this goal. However, little is known about factors that determine acceptability...

  • Temporal trends in presentation for outpatient HIV medical care 2000-2010: implications for short-term mortality. Seal, Paula; Jackson, David; Chamot, Eric; Willig, James; Nevin, Christa; Allison, Jeroan; Raper, James; Kempf, Mirjam; Schumacher, Joseph; Saag, Michael; Mugavero, Michael; Seal, Paula S; Jackson, David A; Willig, James H; Nevin, Christa R; Allison, Jeroan J; Raper, James L; Kempf, Mirjam C; Schumacher, Joseph E; Saag, Michael S // JGIM: Journal of General Internal Medicine;Jul2011, Vol. 26 Issue 7, p745 

    Background: Many newly diagnosed patients present to outpatient care with advanced HIV infection. More timely HIV diagnosis and initiation of care has the potential to improve individual health outcomes and has public health implications.Objective: To assess temporal...

  • Tobacco-specific nitrosamines in tobacco from U.S. brand and non-U.S. brand cigarettes. Ashley, David; Beeson, Michelle; Johnson, Diana; McCraw, Joan; Richter, Patricia; Pirkle, James; Pechacek, Terry F.; Song, Siqing; Watson, Clifford; Ashley, David L; Beeson, Michelle D; Johnson, Diana R; McCraw, Joan M; Pirkle, James L; Watson, Clifford H // Nicotine & Tobacco Research;Jun2003, Vol. 5 Issue 3, p323 

    Tobacco-specific nitrosamines (TSNAs) are one of the major classes of carcinogens found in tobacco products. As part of collaborative efforts to reduce tobacco use and resulting disease, the U.S. Centers for Disease Control and Prevention (CDC) carried out a two-phase investigation into the...

  • Barriers and Facilitators to Routine HIV Testing: Perceptions from Massachusetts Community Health Center Personnel. Johnson, Carey V.; Mimiaga, Matthew J.; Reisner, Sari L.; VanDerwarker, Rodney; Mayer, Kenneth H. // AIDS Patient Care & STDs;Nov2011, Vol. 25 Issue 11, p647 

    Since 2006, the Centers for Disease Control and Prevention (CDC) has recommended routine, voluntary HIV testing for persons aged 13-64 in all health care settings, including the elimination of separate informed consent, which remains in effect in five states including Massachusetts. Community...

  • Cost-effectiveness of strategies to improve HIV testing and receipt of results: economic analysis of a randomized controlled trial. Sanders, Gillian D.; Anaya, Henry D.; Asch, Steven; Hoang, Tuyen; Golden, Joya F.; Bayoumi, Ahmed M.; Owens, Douglas K. // JGIM: Journal of General Internal Medicine;Jun2010, Vol. 25 Issue 6, p556 

    Background: The CDC recommends routine voluntary HIV testing of all patients 13-64 years of age. Despite this recommendation, HIV testing rates are low even among those at identifiable risk, and many patients do not return to receive their results.Objective: To examine...

  • Pending laboratory tests and the hospital discharge summary in patients discharged to sub-acute care. Walz, Stacy E.; Smith, Maureen; Cox, Elizabeth; Sattin, Justin; Kind, Amy J. H. // JGIM: Journal of General Internal Medicine;Apr2011, Vol. 26 Issue 4, p393 

    Background: Previous studies have noted a high (41%) prevalence and poor discharge summary communication of pending laboratory (lab) tests at the time of hospital discharge for general medical patients. However, the prevalence and communication of pending labs within a high-risk...

  • Assessing missed opportunities for HIV testing in medical settings. Liddicoat, Rebecca V.; Horton, Nicholas J.; Urban, Renata; Maier, Elizabeth; Christiansen, Demian; Samet, Jeffrey H. // JGIM: Journal of General Internal Medicine;Apr2004, Vol. 19 Issue 4, p349 

    Many HIV-infected persons learn about their diagnosis years after initial infection. The extent to which missed opportunities for HIV testing occur in medical evaluations prior to one's HIV diagnosis is not known. We performed a 10-year retrospective chart review of patients seen at an HIV...


    An introduction is presented wherein the editors discuss various reports published within the issue on topics including different aspects of routine screening programs for HIV in diverse health-care settings, the progress of HIV screening implementation and challenges in screening for HIV and...

  • HIV testing of at risk patients in a large integrated health care system. Owens, Douglas K.; Sundaram, Vandana; Lazzeroni, Laura C.; Douglass, Lena R.; Tempio, Patricia; Holodniy, Mark; Sanders, Gillian D.; Shadle, Vera M.; McWhorter, Valerie C.; Agoncillo, Teodora; Haren, Noreen; Chavis, Darlene; Borowsky, Leila H.; Yano, Elizabeth M.; Jensen, Peter; Simberkoff, Michael S.; Bozzette, Samuel A. // JGIM: Journal of General Internal Medicine;Mar2007, Vol. 22 Issue 3, p315 

    Objective: Early identification of HIV infection is critical for patients to receive life-prolonging treatment and risk-reduction counseling. Understanding HIV screening practices and barriers to HIV testing is an important prelude to designing successful HIV screening programs. Our...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics