An overview of consent requirements for HIV and viral hepatitis B and C testing in Europe.

BACKGROUND

Complicated consent procedures for bloodborne virus (HIV, HBV and HCV) testing present barriers to implementation, particularly in non-specialist healthcare settings. European and global guidelines no longer recommend written consent. An overview of testing consent requirements in Europe is lacking.

METHODS

An online survey on legal and policy frameworks and implementation/practice was developed by a working group under the EuroTEST Initiative and disseminated to clinical and community-based testing facilities and national public health institutions and/or HIV/hepatitis organizations/societies in the countries of the WHO European Region. Data collection and validation occurred between October 2023 and April 2024. Responses were validated via email and/or bilateral discussions if diverging across same-country respondents to obtain one answer per country.

FINDINGS: A total of 84 responses from 36 community-based testing sites, 33 healthcare facilities and 15 public health institutes in 34 countries were included. Written or documented verbal consent remained a policy requirement for HIV testing in 12 countries (4/18 western, 6/11 central, 2/5 eastern). For viral hepatitis, opt-out testing was much more common and written/documented verbal consent a policy requirement in five countries only. Practices for how consent is obtained in reality varied by setting and did not always follow legal/policy requirements.

INTERPRETATION: Written/documented consent remains a requirement for HIV testing in more than a third of responding countries. Removing the need for written/documented verbal consent and expanding opt-out testing will reduce testing barriers, reduce HIV exceptionalism, align national requirements with global standards and support European countries in reaching the first UNAIDS 95-95-95 target of 95% of those infected, diagnosed.