HIV Testing Policy Update: Opt-out Testing

May 23, 2022

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ASHMs HIV Testing Policy has now been updated to include opt-out testing.

ASHM is pleased to announce that our National HIV Testing Policy has now been updated to include a section covering opt-out testing.

‘Opt-out’ HIV testing is provider-initiated testing where a person in a clinical setting understands that testing is voluntary and will be performed unless they explicitly decline. Under these circumstances, consent may be obtained by advising through verbal, written or electronic means that HIV testing is performed by the service routinely unless declined.

Opt-out HIV testing has been found to be acceptable to patients in GP settings, increase HIV testing in sexual health clinic settings, and to be a feasible strategy for identifying people with previously undiagnosed HIV infection who might not otherwise access HIV testing services. Opt-out HIV testing programs in emergency departments have also been found to identify people living with HIV who have been previously diagnosed but lost to care, and successfully re-link them to HIV care.

UNAIDS and the World Health Organisation recommend that in countries such as Australia with concentrated HIV epidemics provider-initiated (opt-out) HIV testing should be considered in various settings, including:

STI services

Services for most-at-risk populations
Antenatal, childbirth, and postpartum health services

TB services

These settings are considered especially important as people attending these services may assume that HIV testing occurs routinely when blood testing occurs. A recent study of STI and BBV knowledge, behaviour and service access among people from culturally and linguistically diverse backgrounds in Australia found that although over 90% of participants had heard of HIV, only approximately one third of those (in Western Australia and South Australia) to one half (in Queensland) were aware that HIV testing is not performed whenever someone has a blood test. Additionally, in data collected from clinics in the ACCESS Network in New South Wales, it has been reported that by the end of 2020 only 53% of gay and bisexual men attending high gay caseload GP practices had had an HIV test in the previous 12 months.

As with all testing, services and healthcare providers must ensure persons tested receive results – both positive and negative – in a timely manner, and that those diagnosed receive continuity of care and the opportunity for counselling and referral as appropriate. This will ensure testing programs increase engagement in care for new diagnoses and re-engagement in care for those who are not receiving it and/or who were lost to follow up.

View the National HIV Testing Policy here and the full Opt-out Testing section here.

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