Theme: Epidemiology & Public Health Research Year: 2024
Background: Infectious disease screening is a critical element in harm reduction strategies at syringe services programs (SSPs) due to the high risk of HIV and HCV transmission associated with injection drug use. Traditional opt-in testing models have shown low participation rates, which can hinder early detection and treatment efforts. We demonstrate how the shift to an opt-out screening model at our SSP vastly improved screening rates and public health outcomes.
Approach: Our SSP implemented a clinical opt-out model for HIV and HCV screening, integrating routine anonymous screenings within a low-barrier approach, informing participants that testing will occur unless they explicitly decline, thereby simplifying the consent process and reducing stigma. Screenings are conducted at enrollment and repeated quarterly, with options to switch to confidential to start treatment. We emphasize person-centered care and maintain a non-stigmatizing environment, ensuring high retention rates.
Analysis: The implementation of the opt-out model increased screening rates over 1000%; from 214 HIV screens in year one, to 2402 by year three, and 230 HCV screens in year one to 2859 screens by year three, with only 7 out of 1761 participants opting out since the program’s inception. The approach has facilitated early detection and treatment, leading to better health outcomes and reduced transmission of HIV and HCV. Key factors contributing to this success include routine screening, voluntary anonymity, person-centered care, separation of research and clinical operations, and a low-barrier model. Participants have responded positively, highlighting the program’s non-stigmatizing approach and flexibility in screening options.
Conclusion: SSPs should consider an opt-out low barrier-approach screening model as an emerging best practice to enhance HIV/HCV screening. It is essential to maintain a non-stigmatizing environment and offer flexible screening options to accommodate diverse participant needs. Continuous evaluation and adaptation of the program based on participant feedback will further improve its effectiveness.
Download abstract