Universal Opt-Out HIV Screening in Phoenix


A screening program using a fourth-generation HIV test identified 78 unsuspected infections among nearly 28,000 tests.


In 2011, Arizona’s principal safety net emergency department (ED) implemented universal opt-out HIV screening using a new (fourth-generation) test that detects both HIV antigen and anti-HIV antibody (Architect HIV Ag/Ab Combo Test; Abbott Laboratories). All positive results were confirmed by Western blot testing. Patients aged 18 to 64 undergoing venipuncture as part of their ED care were informed at triage that they would be tested and were given an informed-consent brochure; at this time they could opt out.

During 2011 to 2014, nearly 28,000 HIV tests were performed on 22,500 patients. The test was positive in 105 cases (0.38%), but 27 (26%) were found to be false-positive results on confirmatory testing. There were 78 confirmed HIV diagnoses (0.28% of all tests), and of these, 18 (23%) were acute infections. Overall, 35% of patients declined testing.


The CDC recommends universal screening in populations with a prevalence of HIV infection above a threshold of 0.1%, which is well below the 0.28% in this study. Two major impediments to detection of unsuspected HIV infection are high false-positive rates of screening assays and HIV exceptionalism. The new assay seems accurate, with only 0.1% false-positive results. The program also eliminated much of the exceptionalism problem by using an “opt-out” approach instead of an “opt-in” approach, but still, triage nurses were required to announce the plan and hand out a brochure. We should eliminate all barriers and avoidable costs to HIV screening, and we should screen blood whenever it passes through our laboratories. Until regulators permit this without exceptional forms of consent and counseling, the nation’s EDs will likely not be able to take on the added work.


  1. Geren KI et al. Identification of acute HIV infection using fourth-generation testing in an opt-out emergency department screening program. Ann Emerg Med 2014 Jun 22; [e-pub ahead of print]. (http://dx.doi.org/10.1016/j.annemergmed.2014.05.021)

– See more at: http://www.jwatch.org/na35090/2014/07/03/universal-opt-out-hiv-screening-phoenix#sthash.vTZRNxWx.dpuf