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.