title: Opt-out and opt-in testing increases syphilis screening of HIV-positive men who have sex with men in Australia.
abstract: BACKGROUND
  Since 2005, Australian clinicians were advised to undertake quarterly syphilis testing for all sexually active HIV-positive men who have sex with men (MSM). We describe differences in syphilis testing frequency among HIV-positive MSM by clinic testing policies since this recommendation.
  
  
  METHODS
  Three general practices, two sexual health clinics and two hospital HIV outpatient clinics provided data on HIV viral load and syphilis testing from 2006-2010. Men having ≥1 viral load test per year were included; >95% were MSM. We used Chi-2 tests to assess changes in syphilis testing frequency over time, and differences by clinic testing policy (opt-out, opt-in and risk-based).
  
  
  RESULTS
  The proportion of men having HIV viral loads with same-day syphilis tests increased from 37% in 2006 to 63% in 2007 (p<0.01) and 68-69% thereafter. In 2010, same-day syphilis testing was highest in four clinics with opt-out strategies (87%, range:84-91%) compared with one clinic with opt-in (74%, p = 0.121) and two clinics with risk-based strategies (22%, range:20-24%, p<0.01). The proportion of men having ≥3 syphilis tests per year increased from 15% in 2006 to 36% in 2007 (p<0.01) and 36-38% thereafter. In 2010, the proportion of men having ≥3 syphilis tests in a year was highest in clinics with opt-out strategies (48%, range:35-59%), compared with opt-in (39%, p = 0.121) and risk-based strategies (8.4%, range:5.4-12%, p<0.01).
  
  
  CONCLUSIONS
  Over five years the proportion of HIV-positive men undergoing syphilis testing at recommended frequencies more than doubled, and was 5-6 times higher in clinics with opt-out and opt-in strategies compared with risk-based policies.
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia. Rguy@kirby.unsw.edu.au
authors.forename: Rebecca
authors.initials: R
authors.lastname: Guy
authors.forename: Carol
authors.initials: C
authors.lastname: El-Hayek
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Fairley
authors.forename: Handan
authors.initials: H
authors.lastname: Wand
authors.forename: Andrew
authors.initials: A
authors.lastname: Carr
authors.forename: Anna
authors.initials: A
authors.lastname: McNulty
authors.forename: Jenny
authors.initials: J
authors.lastname: Hoy
authors.forename: Christopher
authors.initials: C
authors.lastname: Bourne
authors.forename: John
authors.initials: J
authors.lastname: McAllister
authors.forename: B K
authors.initials: BK
authors.lastname: Tee
authors.forename: David
authors.initials: D
authors.lastname: Baker
authors.forename: Norman
authors.initials: N
authors.lastname: Roth
authors.forename: Mark
authors.initials: M
authors.lastname: Stoove
authors.forename: Marcus
authors.initials: M
authors.lastname: Chen
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D060085:Coinfection; D006679:HIV Seropositivity / Q000821:virology; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D013587:Syphilis / Q000175:diagnosis* / Q000453:epidemiology*; D019562:Viral Load; D055815:Young Adult