HIV pre-test practices: an online survey examining perceptions of informed consent and pre-test information delivery in health care settings across the WHO European Region

The objective of this study was to gather health professionals' perceptions about gaining informed consent and delivering HIV pre-test information. An online self-report survey was completed by 338 respondents involved in HIV testing in 55 countries in the WHO European Region. Nearly two thirds (61.5%) of respondents thought that HIV testing guidelines used in their country of work included recommendations about pre-test information; 83% thought they included recommendations regarding obtaining informed consent. One third (34%) of respondents thought that written informed consent was required; respondents from Eastern Europe and Central Asia were more likely to perceive this as required. Respondents from Western Europe thought pre-test information about the following aspects was significantly less likely to be addressed than respondents in other regions: the right to decline a test; services available after a positive test; laws/regulations impacting someone being tested and receiving a positive test result; potential risks for a client taking an HIV test; the possible need for partner notification after a positive test result. Results offer insight into perceived HIV pre-test practices in all but two national settings across the WHO European Region, and can be used in the development and evaluation of future HIV testing guidelines in the WHO European Region. Findings highlight that practices of obtaining written informed consent depart from current guidelines in some HIV testing settings. Furthermore, findings underscore that it is uncommon for pre-test information to address legal and social risks and harms that people testing HIV-positive may incur. This differs from the most recent global WHO guidelines emphasising the importance of such information, and raises important questions regarding the implications and appropriateness of the currently dominant focus of recommendations on streamlining the HIV testing process.