Objectives: In January 2007, opt-out HIV testing replaced provider-initiated testing strategy at the Sexually Transmitted Infections (STI) outpatient clinic in Amsterdam, The Netherlands (about 25,000 consultations/year). We studied the effect of the opt-out strategy on the uptake of HIV testing and identified factors associated with refusal of HIV testing.
Study Design: Data routinely collected at the STI clinic, were analyzed separately for men having sex with men (MSM) and heterosexuals. Logistic regression analysis was used to identify factors associated with opting out.
Results: In 2007, 12% of MSM and 4% of heterosexuals with (presumed) negative or unknown HIV serostatus declined HIV testing. Refusals gradually decreased to 7% and 2% by year-end. In 2006, before the introduction of opt-out, 38% of MSM and 27% of heterosexuals declined testing. The proportion of HIV-positive results remained stable; among MSM, 3.4%(117/3,442) in 2007 versus 3.7%(95/2525) in 2006 and, among heterosexuals, 0.2%(44/20,468) in 2007 versus 0.3%(36/14,067) in 2006. In both groups factors associated with opting out were: age ≥ 30 years, no previous HIV test, the presence of STI-related complaints, and not reporting risky anal/vaginal intercourse. Among heterosexuals, men and non-Dutch visitors refused more often; among MSM, those warned of STI exposure by sexual partners and those diagnosed with gonorrhoea or syphilis refused more often.
Conclusions: An opt-out strategy increased the uptake in HIV testing. A sharp increase in testing was followed by a more gradual increase, suggesting time must pass to optimize the new strategy. A small group of visitors, especially MSM, still opt-out. We will focus our counselling on barriers as fear and low risk perception among high-risk visitors considering opting out.