title: Opting out increases HIV testing in a large sexually transmitted infections outpatient clinic.
abstract: OBJECTIVE
  In January 2007, opt-out HIV testing replaced provider-initiated testing at the sexually transmitted infections (STI) outpatient clinic in Amsterdam, The Netherlands. The effect of the opt-out strategy on the uptake of HIV testing was studied and factors associated with refusal of HIV testing were identified.
  
  
  METHODS
  Data routinely collected at the STI clinic were analysed separately for men who have 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 the 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% in 2007 versus 3.7% in 2006, and among heterosexuals, 0.2% in 2007 versus 0.3% in 2006. In both groups factors associated with opting out were: age >or=30 years, no previous HIV test, the presence of STI-related complaints and no 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 of HIV testing. A sharp increase in testing preceeded a more gradual increase, suggesting time must pass to optimise the new strategy. A small group of visitors, especially MSM, still opt out. Counselling will focus on barriers such as fear and low risk perception among high-risk visitors considering opting out.
authors.affiliation: Cluster of Infectious Diseases, STD Outpatient Clinic, Health Service of Amsterdam, Amsterdam, The Netherlands. theijman@ggd.amsterdam.nl
authors.forename: R L J
authors.initials: RL
authors.lastname: Heijman
authors.forename: I G
authors.initials: IG
authors.lastname: Stolte
authors.forename: H F J
authors.initials: HF
authors.lastname: Thiesbrummel
authors.forename: E
authors.initials: E
authors.lastname: van Leent
authors.forename: R A
authors.initials: RA
authors.lastname: Coutinho
authors.forename: J S A
authors.initials: JS
authors.lastname: Fennema
authors.forename: M
authors.initials: M
authors.lastname: Prins
mesh_terms: D015492:AIDS Serodiagnosis / Q000523:psychology / Q000706:statistics & numerical data*; D000328:Adult; D000367:Age Factors; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D015397:Program Evaluation; D045808:Refusal to Participate / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D012309:Risk-Taking; D012725:Sexual Behavior / Q000208:ethnology / Q000706:statistics & numerical data; D014195:Travel; D055815:Young Adult