Projected Survival Gains from Revising State Laws Requiring Written Opt-in Consent for HIV Testing

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.