‘Opt-Out,’ Mandatory Infant Testing Can Increase Number of Pregnant Women Tested for HIV

"Voluntary opt-out" HIV testing and mandatory newborn infant HIV testing can increase the number of pregnant women tested for HIV, compared to the number of women who are tested under the most common "voluntary opt-in" approach, according to a report published today in the CDC's Morbidity and Mortality Weekly Report, Reuters Health reports. High rates of prenatal HIV testing have been found to lower the risk of vertical transmission for the virus because HIV-positive women can take antiretroviral drugs, have a caesarean section delivery and avoid breastfeeding if they know their status (Rauscher, Reuters Health, 11/14). Researchers examined both U.S. and Canadian HIV testing data from three previously published studies (Roome et al., MMWR, 11/15). For the voluntary opt-out approach, women are "essentially told that HIV testing is the standard here and if you don't want it, we won't do it, but otherwise we will," according to Dr. Harold Jaffe of the CDC. Researchers found prenatal HIV testing rates were between 85% and 98% with the voluntary opt-out approach. For the mandatory approach, utilized in New York and Connecticut, "if you are not tested during pregnancy ... the state can test your infant with or without your permission," Jaffe said. Researchers found "similarly high" results with this approach in New York and Connecticut, ranging from 81% to 93%. Comparatively, voluntary opt-in approaches are linked to a "wide range of testing rates" -- from 25% to 83%, Reuters Health reports. Researchers also found that states switching from an opt-in approach to either of the two other options saw increases in their prenatal HIV testing rates. The study authors concluded that the "data suggest that jurisdictions that use an opt-in approach and that have low prenatal HIV-testing rates should reevaluate their approach" (Reuters Health, 11/14).