New study debunks misconceptions about barriers to the CDC's HIV testing recommendations

Since the Centers for Disease Control and Prevention (CDC) released revised recommendations for opt-out HIV testing in 2006, there has been significant debate around the barriers to widespread implementation of the recommendations.

A new study by a Robert Wood Johnson Clinical Scholar at the University of California, Los Angeles (UCLA) reveals that the majority of states have laws that do not interfere with implementation of the guidelines, and contrary to what some have argued, the guidelines include protections for the patient.

Timely HIV testing continues to be a major public health challenge in the United States. Of the 1 million people in the United States who are HIV infected, 300,000 are unaware of their status and unknowingly infect others, accounting for the majority of new HIV infections. For this reason, the CDC released new guidelines for HIV testing in September of 2006 which recommend opt-out HIV screening of all patients in all health care settings. Despite the revised guidelines, low HIV screening rates persist.

"Patient advocates have voiced opposition to opt-out screening for HIV testing because of legitimate concerns that it would not ensure that patients feel they actually have the choice to accept or decline testing," said Anish P. Mahajan M.D., M.P.H., lead author of the study and a Robert Wood Johnson Foundation Clinical Scholar at UCLA. "We found that The CDC guidelines' definition of 'opt-out' does require specific protection of patient autonomy, which in many cases is not required by state laws. Beyond simply complying with state laws, providers, consumer groups, and other stakeholders should ensure that these protections are adhered to."

According to the CDC recommendations, providers are required to give patients information about the HIV test, ask if the patient has any questions, and inform him/her that they have the right to decline the test.

"Opt-out screening could still result in unintended consequences such as patients avoiding the doctor because they do not want to be asked about HIV testing," cautions Dr. Mahajan who is currently looking at how opt-out HIV screening compares to the more traditional opt-in HIV screening currently used in South Central Los Angeles. Results of this research are expected later this year.

State law on HIV testing is also widely assumed to be a barrier to implementing the recommendations. The researchers performed a state-by-state review of all statutes pertaining to HIV testing and systematically assessed the consistency of these laws with the new recommendations. Major findings of this analysis include the following:

• Thirty-five states, including the District of Columbia, have laws that are consistent with or neutral toward the recommendations.
• In the two years since the release of the recommendations, nine states have passed new laws to move from inconsistent to consistent with the guidelines.
• Sixteen states still have laws that are barriers to the CDC recommendations.