Opt-out testing: who can afford to take care of patients with newly diagnosed HIV infection?

The appropriate adoption of a policy of opt-out universal testing for human immunodeficiency virus (HIV) will likely increase the number of new HIV-infected patients seeking care by at least 25% over the next several years. On the basis of recent analyses, this policy will save lives and reduce medical care costs. However, the majority of clinics are currently operating at maximum capacity and cannot absorb the influx of newly identified patients. Therefore, the implementation of the policy of opt-out testing will expose deficiencies in clinic capacity and will likely precipitate a crisis in health care access and delivery for patients seeking care at these clinics. A comprehensive assessment of the funding requirements of existing HIV clinics is urgently needed, and sufficient resources must be appropriated to ensure that existing clinics can expand their capacity to absorb the onslaught of HIV-infected patients newly identified via the opt-out testing policy.