HIV, trauma and the emergency departments: The CDC opt-out approach should be adopted in South Africa

Timothy Craig Hardcastle, Bhakti Hansoti


Background. Trauma is the fourth burden of disease in South Africa (SA). The risk group is the same as that for HIV/AIDS. The Centers for Disease Control and the World Health Organization promulgated the opt-out testing system 10 years ago and several high- and lower-middleincome countries have adopted this approach.

Objective. To review the feasibility of implementing the opt-out system in SA emergency departments.

Methods. We examined the clinical, economic, practical and patient/provider perceptions concerning the scientific and ethical aspects of the opt-out concept.

Results. Patients were generally positive about the opt-out system and the overall test rate and disease identification rates were better than with other systems. Although initial costs may increase, the long-term cost benefit and prevention of transmission, due to linking to care,make this option attractive.

Conclusion. The opt-out option for patients presenting to emergency departments with an acute life-threatening illness or trauma, and for those in critically ill states in an intensive care unit, is justifiable based on international and regional practices. This also has the potential to advance early highly active antiretroviral therapy and reduce treatment costs and the disease-adjusted life years for HIV management and trauma critical care. SA should adopt an opt-out testing system instead of the current tedious opt-in system.

Authors' affiliations

Timothy Craig Hardcastle, Trauma Unit and Dept of Surgery: University of KwaZulu-Natal

Bhakti Hansoti, Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA.

Full Text

PDF (76KB)


HIV; Opt-out; Emergency care; Acceptability; Patient safety; Ethics

Cite this article

South African Journal of Bioethics and Law 2016;9(2):57. DOI:10.7196/SAJBL.2016.v9i2.486

Article History

Date submitted: 2016-06-21
Date published: 2016-10-18

Article Views

Abstract views: 5850
Full text views: 2204

Comments on this article

*Read our policy for posting comments here
  • Good
    "Dina Haines" (2017-08-29)
  • Loop
    "Mr Brad Keat" (2018-03-19)
View all comments