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Effectiveness of opting-out strategy for HIV testing; evaluation of four years of standard HIV testing in an STI clinic
  1. Nicole H T M Dukers (nicole.dukers{at}
  1. South Limburg Public Health Service, Netherlands
    1. Anne-Marie Niekamp (anne-marie.niekamp{at}
    1. South Limburg Public Health Service, Netherlands
      1. Maartje M H Vergoossen (maartje.vergoossen{at}
      1. South Limburg Public Health Service, Netherlands
        1. Christian JPA Hoebe (christian.hoebe{at}
        1. South Limburg Public Health Service, Netherlands


          Objectives: A high proportion of HIV infected individuals is unaware of infection. They miss the opportunity for timely treatment. Our STI clinic recognized the need to increase test rates and routinely included an HIV test, unless the client refuses, in each consultation as of 2004. We evaluated effectiveness of this opting-out approach for HIV testing.

          Methods: We used anonimized data from our STI clinic (South Limburg, The Netherlands) from 2003 to 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 clinic are evaluated as well.

          Results: In South limburg, the number of HIV tests increased strongly, which was mostly due to increasing STI clinic requests and antenatal screening. Of STI clinic attendees, 84% (1,616/1,920) were tested in 2003 and this proportion increased to 96% (3,699/3,836) 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. Findings are now used to develop more effective and tailored HIV/STI counselling in order to further optimize HIV testing practice.

          Conclusions: Standard testing on HIV in an STI clinic is feasible and effective in increasing awareness of ones HIV status. It should be essential part of STI screening in STI clinics and should be considered in other health care settings for specific risk groups as well.

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