Heijman R L J, Stolte I G, Thiesbrummel H F J, van Leent E, Coutinho R A, Fennema J S A, Prins M
Cluster of Infectious Diseases, STD Outpatient Clinic, Health Service of Amsterdam, Amsterdam, The Netherlands.
Sex Transm Infect. 2009 Aug;85(4):249-55. doi: 10.1136/sti.2008.033258. Epub 2008 Dec 22.
In January 2007, opt-out HIV testing replaced provider-initiated testing at the sexually transmitted infections (STI) outpatient clinic in Amsterdam, The Netherlands. The effect of the opt-out strategy on the uptake of HIV testing was studied and factors associated with refusal of HIV testing were identified.
Data routinely collected at the STI clinic were analysed separately for men who have sex with men (MSM) and heterosexuals. Logistic regression analysis was used to identify factors associated with opting out.
In 2007, 12% of MSM and 4% of heterosexuals with (presumed) negative or unknown HIV serostatus declined HIV testing. Refusals gradually decreased to 7% and 2% by the year end. In 2006, before the introduction of opt-out, 38% of MSM and 27% of heterosexuals declined testing. The proportion of HIV-positive results remained stable among MSM, 3.4% in 2007 versus 3.7% in 2006, and among heterosexuals, 0.2% in 2007 versus 0.3% in 2006. In both groups factors associated with opting out were: age >or=30 years, no previous HIV test, the presence of STI-related complaints and no risky anal/vaginal intercourse. Among heterosexuals, men and non-Dutch visitors refused more often; among MSM, those warned of STI exposure by sexual partners and those diagnosed with gonorrhoea or syphilis refused more often.
An opt-out strategy increased the uptake of HIV testing. A sharp increase in testing preceeded a more gradual increase, suggesting time must pass to optimise the new strategy. A small group of visitors, especially MSM, still opt out. Counselling will focus on barriers such as fear and low risk perception among high-risk visitors considering opting out.
2007年1月，荷兰阿姆斯特丹性传播感染（STI）门诊将选择退出式HIV检测取代了由医护人员主动建议的检测方式。研究了选择退出式策略对HIV检测接受率的影响，并确定了与拒绝HIV检测相关的因素。
对STI门诊常规收集的数据分别针对男男性行为者（MSM）和异性恋者进行分析。采用逻辑回归分析确定与选择退出相关的因素。
2007年，HIV血清学状态（假定）为阴性或未知的MSM中有12%、异性恋者中有4%拒绝了HIV检测。到年底时，拒绝率逐渐降至7%和2%。在2006年引入选择退出式检测之前，38%的MSM和27%的异性恋者拒绝检测。MSM中HIV检测呈阳性结果的比例保持稳定，2007年为3.4%，2006年为3.7%；异性恋者中该比例2007年为0.2%，2006年为0.3%。两组中与选择退出相关的因素为：年龄≥30岁、以前未进行过HIV检测、存在与STI相关的症状且无危险的肛交/阴道性交。在异性恋者中，男性和非荷兰籍访客拒绝检测的情况更常见；在MSM中，被性伴侣警告有STI暴露风险的人以及被诊断患有淋病或梅毒的人拒绝检测的情况更常见。
选择退出式策略提高了HIV检测的接受率。检测接受率先急剧上升，随后逐渐上升，这表明必须经过一段时间才能优化新策略。一小部分访客，尤其是MSM，仍然选择退出。咨询将聚焦于考虑选择退出的高危访客中的恐惧和低风险认知等障碍。
