1. Projected survival gains from revising state laws requiring written opt-in consent for HIV testing.
- Author
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April MD, Chiosi JJ, Paltiel AD, Sax PE, and Walensky RP
- Subjects
- Cohort Studies, Diagnostic Tests, Routine methods, HIV Infections mortality, Humans, Predictive Value of Tests, Survival Rate trends, AIDS Serodiagnosis legislation & jurisprudence, HIV Infections diagnosis, Informed Consent legislation & jurisprudence, Models, Statistical, Patient Acceptance of Health Care, State Government
- 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., Design: 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%)., Patients: Hypothetical cohort of adults (>13 years) living in written opt-in states., Measurements: 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.
- Published
- 2011
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