Journal of General Internal Medicine

, Volume 26, Issue 6, pp 661–667

Projected Survival Gains from Revising State Laws Requiring Written Opt-in Consent for HIV Testing

  • Michael D. April
  • John J. Chiosi
  • A. David Paltiel
  • Paul E. Sax
  • Rochelle P. Walensky
Original Research



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.


To quantify potential survival gains from passing state laws streamlining HIV testing consent.


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%).


Hypothetical cohort of adults (>13 years) living in written opt-in states.


Life years gained (LYG).


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%.


The potential survival gains of increased testing are substantial, suggesting that state laws requiring opt-in HIV testing should be revised.

Key Words

HIV AIDS screening modeling survival analysis 

Supplementary material

11606_2011_1637_MOESM1_ESM.doc (132 kb)
APPENDIX TABLE A1State HIV testing data, 2006 (DOC 132 kb)


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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Michael D. April
    • 1
    • 2
  • John J. Chiosi
    • 3
  • A. David Paltiel
    • 4
  • Paul E. Sax
    • 2
    • 5
  • Rochelle P. Walensky
    • 2
    • 3
    • 5
    • 6
  1. 1.Division of General MedicineMGHBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Division of General MedicineMassachusetts General HospitalBostonUSA
  4. 4.Yale School of MedicineNew HavenUSA
  5. 5.Division of Infectious Diseases and Department of General MedicineBrigham and Women’s HospitalBostonUSA
  6. 6.Center for AIDS Research (CFAR)Harvard Medical SchoolBostonUSA

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