‘Opt-out’ testing lacks patient-friendly system

The hugely welcome government-led initiative to pro-actively offer ‘opt-out’ HIV testing to patients at its clinics and hospitals needs hefty back-up resources to ensure patient retention and earlier presentation. These are the chief concerns of the president of the Southern African HIV Clinicians Society, Dr Francois Venter, who said the move by Health Minister, Dr Aaron Motsoaledi last month, showed much-wanted leadership. Until last month people were only tested for HIV if they expressly asked for the test (‘opt-in’), a strongly human-rights based approach which gave greater initiative to the individual but with potent negative implications for containing the pandemic. The World Health Organization advocates an ‘opt-out’ approach and recently issued definitive operational guidelines. ‘The fact that nearly half of all South Africans now know their HIV status1 is a huge step forward from even 18 months ago and this new move will boost that further, but I’m worried that we’re still not getting people to enter the system earlier,’ said Venter. He explained that in spite of the examples being set by some top performing clinics and hospitals ( Esselen Street clinic in Hillbrow tests on average 4 000 people per month), ‘we’re still getting people coming in very late when it’s harder to turn them around’. One major reason for this was the health care system not being friendly enough for people to come forward for testing while they were still healthy