Effectiveness of an opting-out strategy for HIV testing: evaluation of 4 years of standard HIV testing in a STI clinic

Objectives: A high proportion of individuals infected with HIV are unaware of the infection. They miss the opportunity for timely treatment. Our sexually transmitted infection (STI) clinic (South Limburg, The Netherlands) recognised the need to increase test rates and from 2004 routinely includes a HIV test, unless the client refuses, in each consultation. We evaluated the effectiveness of this opting-out approach for HIV testing. Methods: We used anonymised data from our STI clinic from 2003-2007 to assess trends in HIV testing and (reasons for) test refusal using multivariate analyses and interview. Laboratory registry data from the area that is served by the clinic were evaluated as well. Results: In South Limburg the number of HIV tests increased, which was mostly due to increasing STI clinic requests and antenatal screening. Of STI clinic attendees, 84% (1616/1920) were tested in 2003 and this proportion increased to 96% (3699/3836) in 2007. However, 88% (n = 57/65) of men who have sex with men and 44% (191/424) of heterosexuals who refused HIV testing after 2004 were linked to higher STI/HIV risk. Our clinic now uses these findings to develop more effective and tailored HIV/STI counselling in order to further optimise HIV testing practice. Conclusions: Standard testing on HIV in a STI clinic is feasible and effective in increasing awareness of one's HIV status. It should be an essential part of STI screening in STI clinics and should be considered in other healthcare settings for specific risk groups.