title: Projected survival gains from revising state laws requiring written opt-in consent for HIV testing.
abstract: BACKGROUND
  Although the Centers for Disease Control and Prevention recommends HIV testing in all settings unless patients refuse (opt-out consent), many state laws require written opt-in consent.
  
  
  OBJECTIVE
  To quantify potential survival gains from passing state laws streamlining HIV testing consent.
  
  
  METHODS
  We retrieved surveillance data to estimate the current annual HIV diagnosis rate in states with laws requiring written opt-in consent (19.3%). Published data informed the effect of removing that requirement on diagnosis rate (48.5% increase). These parameters then served as input for a model-driven projection of survival based on consent method. Other inputs included undiagnosed HIV prevalence (0.101%); and annual HIV incidence (0.023%).
  
  
  METHODS
  Hypothetical cohort of adults (>13 years) living in written opt-in states.
  
  
  METHODS
  Life years gained (LYG).
  
  
  RESULTS
  In the base-case, of the 53,036,383 adult persons living in written opt-in states, 0.66% (350,040) will be infected with HIV. Due to earlier diagnosis, revised consent laws yield 1.5 LYG per HIV-infected person, corresponding to 537,399 LYG among this population. Sensitivity analyses demonstrate that diagnosis rate increases of 24.8-72.3% result in 304,765-724,195 LYG. Net survival gains vanish if the proportion of HIV-infected persons refusing all testing in response to revised laws exceeds 18.2%.
  
  
  CONCLUSIONS
  The potential survival gains of increased testing are substantial, suggesting that state laws requiring opt-in HIV testing should be revised.
authors.affiliation: Division of General Medicine, MGH, 50 Staniford St, 9th Fl, Boston, MA 02114, USA. Michael_April@hms.harvard.edu
authors.forename: Michael D
authors.initials: MD
authors.lastname: April
authors.forename: John J
authors.initials: JJ
authors.lastname: Chiosi
authors.forename: A David
authors.initials: AD
authors.lastname: Paltiel
authors.forename: Paul E
authors.initials: PE
authors.lastname: Sax
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
mesh_terms: D015492:AIDS Serodiagnosis / Q000331:legislation & jurisprudence*; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine / Q000379:methods; D015658:HIV Infections / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D015233:Models, Statistical; D010342:Patient Acceptance of Health Care; D011237:Predictive Value of Tests; D013219:State Government; D015996:Survival Rate / Q000639:trends