Evidence-Based. Clearly Delivered.
Evidence-Based. Clearly Delivered.
Updated HIV screening and prevention guidance emphasizes that all patients should be offered HIV testing at least once using an opt-out approach. In practical terms, opt-out screening means HIV testing is presented as a routine part of care and is performed unless the patient declines. Rather than asking patients whether they would like an HIV test, clinicians inform them that HIV testing is part of standard preventive care and give them the opportunity to refuse.
The guidance also encourages physicians to take a more proactive role in HIV prevention by routinely discussing risk reduction strategies, including preexposure prophylaxis (PrEP), instead of waiting for patients to raise the topic themselves.
ACOG has updated their guidance to align with the CDC. For many reproductive-age patients, an ob-gyn is their primary or only regular healthcare provider. Routine gynecologic visits create an opportunity to normalize HIV testing, identify patients at increased risk, screen for other sexually transmitted infections, and discuss prevention options before problems arise. The updated guidance also reinforces the importance of taking inclusive, nonjudgmental sexual histories, which can help identify patients who may benefit from more frequent HIV testing or PrEP.
The biggest hurdle is often workflow. To make opt-out screening successful, practices may need to update intake forms, standing orders, laboratory protocols, patient education materials, and EHR prompts so HIV testing is automatically incorporated into routine care rather than relying on individual clinician discretion. Staff should also be prepared to address positive test results, referrals for treatment, partner notification services, pregnancy-related considerations, insurance coverage questions, and ongoing monitoring for patients who start PrEP.
For now, practices should assess whether HIV testing is truly operating as an opt-out process in daily practice. They should also determine who is responsible for PrEP counseling, prescribing, and follow-up. It is worth considering how much has changed since HIV testing first became available in the 1980’s and 1990’s when testing was risk-based, requiring not only extensive pretest counseling but also written consent. The ‘opt out’ concept is actually 20 years old. The big change is the expectation in 2026 that HIV testing should be integrated into routine care.
CDC HIV Nexus: Clinical Testing Guidance for HIV
Routine Opt-Out HIV Screening: More Evidence in Support of Alternative Approaches?
ACOG Committee Statement 32: Human Immunodeficiency Virus Screening and Preexposure Prophylaxis
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