Henderson Heather, Wilson Jason, McCoy Bernice, Sarmento Megan, Oxner Asa
Department of Emergency Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, 33612, USA.
Tampa General Hospital, Tampa, FL, 33606, USA.
Harm Reduct J. 2025 Mar 12;22(1):30. doi: 10.1186/s12954-025-01182-3.
This paper outlines the implementation of opt-out HIV and Hepatitis C (HCV) screening at a syringe services program (SSP) in Florida, highlighting its effectiveness in reducing the transmission of these infectious diseases. Historically, many SSPs have utilized opt-in testing models, which require participants to actively choose testing and often result in low participation rates. Recognizing the need for a more effective approach and to comply with Florida's regulatory requirements under the Infectious Disease Elimination Act, we transitioned to an opt-out testing model at our SSP. This model integrates routine, anonymous, and voluntary testing into standard care, normalizing the process and reducing stigma associated with infectious disease screening. Initially, our policy tied testing to access to specific services, including syringe exchange, to meet compliance with Florida Department of Health mandates. However, after feedback from participants, staff, and community members, we revised our approach to allow all participants to access all services, regardless of their decision to participate in testing. Importantly, this policy change did not decrease testing rates, with only 6 out of 226 new enrollments (3%) opting out since the implementation of opt-out screening. By fostering a trusting, non-coercive environment and normalizing screening as part of routine care, we achieved high rates of participation while maintaining participant autonomy. Since transitioning to an opt-out model, we have conducted nearly 3,000 HIV and HCV tests, with seropositivity rates of 3.8% and 54%, respectively. These efforts have facilitated early detection, rapid linkage to care, and reduced transmission within the community. Our findings underscore the importance of comprehensive, repeat testing in high-risk populations and demonstrate the potential for opt-out models to serve as a scalable framework for SSPs nationwide. This approach not only fulfills regulatory and public health objectives but also strengthens the role of SSPs as critical interventions in combating HIV and HCV transmission.
本文概述了佛罗里达州一个注射器服务项目（SSP）实施的艾滋病病毒（HIV）和丙型肝炎病毒（HCV）主动退出式筛查，强调了其在减少这些传染病传播方面的有效性。从历史上看，许多注射器服务项目采用的是主动参与式检测模式，即要求参与者主动选择检测，这往往导致参与率较低。认识到需要一种更有效的方法，并为了遵守佛罗里达州《传染病消除法》的监管要求，我们在我们的注射器服务项目中过渡到了主动退出式检测模式。这种模式将常规、匿名和自愿检测纳入标准护理，使这一过程常态化，并减少与传染病筛查相关的污名化。最初，我们的政策将检测与获得特定服务（包括注射器交换）挂钩，以符合佛罗里达州卫生部的规定。然而，在收到参与者、工作人员和社区成员的反馈后，我们修改了方法，允许所有参与者获得所有服务，无论他们是否决定参与检测。重要的是，这一政策变化并没有降低检测率，自实施主动退出式筛查以来，226名新登记参与者中只有6人（3%）选择退出。通过营造一个信任、非强制性的环境，并将筛查作为常规护理的一部分使其常态化，我们在保持参与者自主性的同时实现了高参与率。自过渡到主动退出式模式以来，我们已经进行了近3000次HIV和HCV检测，血清阳性率分别为3.8%和54%。这些努力促进了早期发现、快速连接到治疗，并减少了社区内的传播。我们的研究结果强调了在高危人群中进行全面、重复检测的重要性，并证明了主动退出式模式作为全国注射器服务项目可扩展框架的潜力。这种方法不仅实现了监管和公共卫生目标，还加强了注射器服务项目作为抗击HIV和HCV传播关键干预措施的作用。
