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A study design feature that may contribute to differences in refusal bias is the protocol for post-test counseling and the return of test results.
Thirteen patients were found to carry a deleterious variant in a cancer susceptibility gene that met the criteria for return of test results (Table 2).
In this sample, bias is limited if respondents are offered the opportunity to opt out of post-test counseling and the return of test results.
Agreeing to post-test counseling and the return of test results is often a prerequisite of study participation in health facility-based studies.
With the increasing availability and reliability of rapid tests, the return of test results is now feasible in the same session in which the specimens are collected.
Addressing these difficulties, several primary care-based studies suggest providing patients with detailed instructions on the collection, storage and return of test kits, can increase compliance (Miller et al, 2005; Stokamer et al, 2005).
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Patients had the choice between three consent levels: testing and post-test counseling (including the return of HIV test results), testing without post-test counseling, and total refusal.
Bias is larger when post-test counseling and the return of HIV test results is a prerequisite of study participation (compared to a protocol where test results are not returned to study participants, or, where there is an explicit provision for respondents to forego post-test counseling).
The protocol for post-test counseling and the return of HIV test results to study participants is an important determinant of consent for testing, and should be carefully evaluated in studies that wish to minimize refusal bias in HIV prevalence surveys.
Bias is much smaller, and only marginally statistically significant, when the study protocol explicitly allows participants to opt out of post-test counseling and the return of HIV test results.
The protocol for post-test counseling and the return of HIV test results to study participants is an important consideration in HIV prevalence surveys that wish to minimize refusal bias.
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