Australian health care providers’ views on opt-out HIV testing

Abstract

BackgroundOpt-out HIV testing is a novel concept in Australia. In the opt-out approach, health care providers (HCPs) routinely test patients for HIV unless they explicitly decline or defer. Opt-out HIV testing is only performed with the patients’ consent, but pre-test counselling is abbreviated. Australian national testing guidelines do not currently recommend opt-out HIV testing for the general population. Non-traditional approaches to HIV testing (such as opt-out) could identify HIV infections and facilitate earlier treatment, which is particularly important now that HIV is a chronic, manageable disease. Our aim was to explore HCPs’ attitudes toward opt-out HIV testing in an Australian context, to further understanding of its acceptability and feasibility.MethodsIn this qualitative study, we used purposeful sampling to recruit HCPs who were likely to have experience with HIV testing in Western Australia. We interviewed them using a semi-structured guide and used content analysis as per Graneheim to code the data. Codes were then merged into subcategories and finally themes that unified the underlying concepts. We refined these themes through discussion among the research team.ResultsTwenty four HCPs participated. Eleven participants had a questioning attitude toward opt-out HIV testing, while eleven favoured the approach. The remaining two participants had more nuanced perspectives that incorporated some characteristics of the questioning and favouring attitudes. Participants’ views about opt-out HIV testing largely fell into two contrasting themes: normalisation and routinisation versus exceptionalism; and a need for proof versus openness to new approaches.ConclusionMost HCPs in this study had dichotomous attitudes toward opt-out HIV testing, reflecting contrasting analytical styles. While some HCPs viewed it favourably, with the perceived benefits outweighing the perceived costs, others preferred to have evidence of efficacy and cost-effectiveness.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2229-9) contains supplementary material, which is available to authorized users.

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“…Although Australia has been recognised for its leadership in HIV prevention, to our knowledge, opt-out HIV testing has never been explored in Australian general practice. Our previous study of Australian healthcare providers' views on opt-out HIV testing found that half of the participating GPs questioned the acceptability and feasibility of the approach (Leidel et al 2015).…”

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“…‘Perceived barriers’ are health care providers' negative beliefs about opt‐out HIV testing that could limit their willingness to adopt such an approach. For example, health care providers may assume that their patients are unwilling to be tested for HIV or that testing would lead to anxiety or stigma . Some health care providers may be concerned when opt‐out HIV testing is performed with abbreviated pre‐test counselling and simplified consent .…”