title: 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.
abstract: BACKGROUND
  Populations 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.
  
  
  METHODS
  Data 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 had patient-visits was calculated for the overall population and stratified by hospital setting, age, sex, race/ethnicity, homelessness status, insurance status and primary language.
  
  
  RESULTS
  By 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Division of Infectious Diseases, University of California San Francisco, San Francisco, California, United States of America. nzetola@gmail.com
authors.forename: Nicola M
authors.initials: NM
authors.lastname: Zetola
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Grijalva
authors.forename: Sarah
authors.initials: S
authors.lastname: Gertler
authors.forename: C Bradley
authors.initials: CB
authors.lastname: Hare
authors.forename: Beth
authors.initials: B
authors.lastname: Kaplan
authors.forename: Teri
authors.initials: T
authors.lastname: Dowling
authors.forename: Grant
authors.initials: G
authors.lastname: Colfax
authors.forename: Mitchell H
authors.initials: MH
authors.lastname: Katz
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
mesh_terms: D015492:AIDS Serodiagnosis / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D032962:Consent Forms; D003955:Diagnostic Tests, Routine; D015658:HIV Infections / Q000175:diagnosis*; D006268:Health Facilities / Q000592:standards; D006291:Health Policy; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards; D014481:United States