Simplifying Consent for HIV Testing Is Associated with an Increase in HIV Testing and Case Detection in Highest Risk Groups, San Francisco January 2003–June 2007

Nicola M Zetola,Teri Dowling,Mitchell H Katz,Beth Kaplan,Jeffrey D Klausner,C Bradley Hare,Grant Colfax,Carlos G Grijalva,Sarah Gertler

doi:10.1371/journal.pone.0002591

Abstract

BackgroundPopulations at highest risk for HIV infection face multiple barriers to HIV testing. To facilitate HIV testing procedures, the San Francisco General Hospital Medical Center eliminated required written patient consent for HIV testing in its medical settings in May 2006. To describe the change in HIV testing rates in different hospital settings and populations after the change in HIV testing policy in the SFDH medical center, we performed an observational study using interrupted time series analysis.MethodsData from all patients aged 18 years and older seen from January 2003 through June 2007 at the San Francisco Department of Public Health (SFDPH) medical care system were included in the analysis. The monthly HIV testing rate per 1000 hadpatient-visits was calculated for the overall population and stratified by hospital setting, age, sex, race/ethnicity, homelessness status, insurance status and primary language.ResultsBy June 2007, the average monthly rate of HIV tests per 1000 patient-visits increased 4.38 (CI, 2.17–6.60, p<0.001) over the number predicted if the policy change had not occurred (representing a 44% increase). The monthly average number of new positive HIV tests increased from 8.9 (CI, 6.3–11.5) to 14.9 (CI, 10.6–19.2, p<0.001), representing a 67% increase. Although increases in HIV testing were seen in all populations, populations at highest risk for HIV infection, particularly men, the homeless, and the uninsured experienced the highest increases in monthly HIV testing rates after the policy change.ConclusionsThe elimination of the requirement for written consent in May 2006 was associated with a significant and sustained increase in HIV testing rates and HIV case detection in the SFDPH medical center. Populations facing the higher barriers to HIV testing had the highest increases in HIV testing rates and case detection in response to the policy change.

Highlights

Populations at highest risk for HIV infection in the United States still exhibit the greatest gap between intention to test and actual testing [1]
We previously reported that the policy change was associated with a significant increase in HIV testing rates and HIV case detection [4]
A total of 20,710 HIV tests were performed at the San Francisco Department of Public Health (SFDPH) medical center from January 2003 through June 2007 (Table 1)

Summary

Introduction

Background Populations at highest risk for HIV infection in the United States still exhibit the greatest gap between intention to test and actual testing [1]. Integration of HIV screening into routine medical care and the elimination of structural barriers to testing have the potential to increase overall HIV testing and case detection, among populations at highest risk for HIV infection [2,3]. In May 2006, the San Francisco Department of Public Health (SFDPH) medical care system eliminated the requirement for separate written consent for HIV testing within medical settings [4]. To facilitate HIV testing procedures, the San Francisco General Hospital Medical Center eliminated required written patient consent for HIV testing in its medical settings in May 2006. To describe the change in HIV testing rates in different hospital settings and populations after the change in HIV testing policy in the SFDH medical center, we performed an observational study using interrupted time series analysis

Methods

Results

Conclusion