Evaluation of a HIV Voluntary Opt-Out Screening Program in a Singapore Hospital

Abstract

BackgroundEarly diagnosis of human immunodeficiency virus (HIV) allows for appropriately timed interventions with improved outcomes, but HIV screening among asymptomatic persons and the general population in Singapore remains low. In 2008, Singapore’s Ministry of Health implemented HIV voluntary opt-out screening (VOS) for hospitalised adults. We evaluated the outcome of VOS and surveyed reasons for its low uptake in our institution.MethodsWe assessed the outcomes of the VOS programme from January 2010 to December 2013 at National University Hospital, a 1081-bed tertiary hospital in Singapore. We also examined reasons for opting-in and opting-out using an interviewer–administered structured questionnaire in a representative sample in January 2013.Results107,523 patients fulfilled VOS criteria and were offered HIV screening, of which 5215 (4.9%) agreed to testing. 4850 (93.1%) of those who opted-in had an HIV test done. Three (0.06%) tested positive for HIV. 238 patients (14.2%) were surveyed regarding reasons for opting-in or out of VOS. 21 (8.8%) had opted-in. Patients who opted-in were likely to be younger, more educated and reported having more regular sexual partners. Type of housing, number of casual sexual partners, sexual orientation, intravenous drug use, condom use and previous sexually transmitted infection were not associated with deciding to opt-in/out. Patients’ most common reasons for opting-out were: belief that they were at low risk (50.2%), belief that they were too old (26.8%), cost (6.9%) and aversion to venepuncture (6.5%). The most common reason for opting-in was desire to know their HIV status (47.6%).ConclusionThe success of an HIV-VOS program is largely determined by test uptake. Our study showed that the majority of eligible VOS patients opted-out of HIV screening. Given the considerable cost and low yield of this programme, more needs to be done to better equip patients in self-risk assessment and opting in to testing.

Opt‐out screening strategy for HIV infection among patients attending emergency departments: systematic review and meta‐analysis

“…Two of the studies and D’ Almeida et al ., 2012 were carried out in France, Tan et al . was carried out in Singapore, and the remaining 25 were carried out in the USA. We identified ten opt‐out studies.…”

What are the factors associated with human immunodeficiency virus/sexually transmitted infection screening behaviour among heterosexual men patronising entertainment establishments who engaged in casual or paid sex? – Results from a cross-sectional survey in an Asian urban setting

“…Other studies in Singapore have also reported that the non-Chinese were more likely to take up HIV screening than the Chinese [29, 30]. In 2008, Singapore implemented HIV voluntary opt-out screening (VOS) for hospitalised adults.…”

“…The Chinese were more likely to opt-out compared to the non-Chinese in the second largest acute care general hospital in Singapore in 2009–2010 [29]. In another major tertiary hospital in Singapore, 94.9% of the Chinese opt-out of the HIV VOS, compared to 84.1% of Indians and 86.7% of Malays [30]. The reasons for the ethnic differences in Singapore remain unclear.…”

“…Of the new cases in 2014, only 14% were detected through voluntary testing, and this was lowest for heterosexual men among the priority groups [28]. Apart from the different modes of sexual transmission, there were ethnic differences in HIV screening behaviour among the general population in Singapore, with non-Chinese (consisting of mainly Malays and Indians) being more likely than the Chinese to undergo screening [29, 30]. Till now, it is unclear whether these ethnic differences also existed among sexually active heterosexual men.…”

A Cross-Sectional Study Comparing Two Opt-Out HIV Testing Strategies in the Out-Patient Setting

“…Regardless of whether the setting was within a low prevalence (primary care) or high-risk (hepatology clinic) population, there was a low perceived risk of infection-the main barrier to testing. A similar phenomenon is seen worldwide (6,(14)(15)(16)(17). Methods for HIV screening remained a problem and was the second most commonly cited reason for opting out; In the primary care setting, use of rapid finger-prick testing failed to ease fears of venipuncture.…”