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.


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