Mandatory Reporting of HIV Infection Does Not Reduce Number Of HIV Tests Given, Study Says
Mandatory reporting of HIV infection to public health authorities does not adversely affect the number of HIV tests administered, according to a study published in the March 18 issue of the Canadian Medical Association Journal. Canadian researchers studied data from the Provincial Laboratory for Public Health on the number of HIV tests administered between Jan. 1, 1993, and Dec. 31, 2000, for men and women in Alberta, Canada. Researchers also obtained information from the Canadian Blood Services laboratories to determine the number of tests conducted as part of the mandatory prenatal HIV testing program, from which pregnant women could choose to opt-out. The reporting of HIV infection became mandatory in Alberta on May 1, 1998, and opt-out prenatal testing, in which all pregnant women seeking prenatal care are tested for HIV unless they specifically choose not to be tested, was introduced on Sept. 1, 1998. Researchers found that for men, the average annual percent increase in the number of HIV tests was 4% for the period before mandatory testing, compared to 4.3% after mandatory testing was instituted. For women, the average annual percent increase in the number of HIV tests was 9.2% before mandatory testing, but in the month "immediately following" the institution of opt-out prenatal HIV testing the rate increased by 28%. Between 1999 and 2000, the average annual percent increase in the number of HIV tests among females was 1.4%, according to the study. The authors state that mandatory reporting of HIV infection "did not appear to have a deterrent effect" on rates of HIV testing, and the implementation of an opt-out prenatal HIV testing policy "resulted in a dramatic increase in the number of females being tested for HIV infection." They concluded that the findings were "reassuring" and that "continued monitoring and evaluation are required to ensure that surveillance policies do not adversely affect HIV testing" (Jayaraman et al., CMAJ, 3/18).
Opt-Out vs. Opt-In
Screening pregnant women for HIV "clearly represents an important opportunity to prevent the transmission of the virus to infants," Sharon Walmsley, associate professor of medicine at the University of Toronto and assistant director of Toronto Hospital's Immunodeficiency Clinic, writes in an accompanying CMAJ commentary. She states that the previous study demonstrates that "testing rates improve with the opt-out approach" to prenatal HIV testing. For "optimal use" of an opt-out approach, doctors "must be certain that the objectives, risks and benefits of the strategy are explained to their patients and that the women understand their right to refusal." Walmsley also says that women who test positive and women who refuse testing should "not be denied prenatal or obstetric care or be discriminated against in other ways," adding that they should be offered "thorough and informed" pretest counseling. She concludes, "This approach should be adopted in the remaining jurisdictions with opt-in strategies, where testing rates remain suboptimal and HIV-infected children continue to be born" (Walmsley, Canadian Medical Association Journal, 3/18).