Knowledge of treatment to reduce perinatal human immunodeficiency virus (HIV) transmission and likelihood of testing for HIV: results from two surveys of women of childbearing age

HIV knowledge and attitudes among minority pregnant patients and their non-pregnant partners in an urban hospital clinic

OBJECTIVE

HIV seroconversion during pregnancy disproportionately affects urban, minority pregnant individuals. In order to prevent perinatal HIV transmission, it is essential that individuals are aware of HIV risk factors and effective transmission prevention strategies are employed. Thus, we aimed to examine knowledge about HIV transmission and attitudes about HIV among low-income, minority pregnant individuals and their partners living in a high HIV prevalence area.

METHODS

In this qualitative study, pregnant participants were HIV-seronegative individuals receiving publicly-funded prenatal care in an urban academic center in the United States. Pregnant individuals and their partners were recruited to participate in a quality improvement program offering HIV testing to partners of pregnant people. Semi-structured guides were used to conduct individual interviews about participant sources of information about HIV, knowledge about transmission, and attitudes regarding those living with HIV. Transcripts were analyzed using the constant comparative method to determine themes and subthemes.

RESULTS

Of 51 participants, 29 were pregnant individuals and 22 were non-pregnant partners. We found that inaccurate knowledge about perinatal HIV transmission was prevalent. Sources of information about HIV included reputable literary information or educational experiences, broadcast media, and word-of-mouth sources. Participants held dichotomous perceptions of people living with HIV.

CONCLUSIONS

Among low-income, minority pregnant people and their partners in a high HIV prevalence area, inaccuracies and lack of knowledge about HIV transmission were common. Efforts to educate pregnant individuals and their partners about HIV and perinatal HIV transmission should address common misconceptions and use popular sources of information.

HIV testing among pregnant women in Brazil: rates and predictors

OBJECTIVE

To assess rates of offering and uptake of HIV testing and their predictors among women who attended prenatal care.

METHODS

A population-based cross-sectional study was conducted among postpartum women (N=2,234) who attended at least one prenatal care visit in 12 cities. Independent and probabilistic samples were selected in the cities studied. Sociodemographic data, information about prenatal care and access to HIV prevention interventions during the current pregnancy were collected. Bivariate and multivariate analyses were carried out to assess independent effects of the covariates on offering and uptake of HIV testing. Data collection took place between November 1999 and April 2000.

RESULTS

Overall, 77.5% of the women reported undergoing HIV testing during the current pregnancy. Offering of HIV testing was positively associated with: previous knowledge about prevention of mother-to-child transmission of HIV; higher number of prenatal care visits; higher level of education and being white. HIV testing acceptance rate was 92.5%.

CONCLUSIONS

The study results indicate that dissemination of information about prevention of mother-to-child transmission among women may contribute to increasing HIV testing coverage during pregnancy. Non-white women with lower level of education should be prioritized. Strategies to increase attendance of vulnerable women to prenatal care and to raise awareness among health care workers are of utmost importance.

HIV testing in a national sample of pregnant US women: Who is not getting tested?

It is recommended that all pregnant women in the US receive an HIV test as early as possible during prenatal care to allow HIV-infected women to begin receiving anti-retroviral drugs when they most effectively prevent transmission. We analyzed interview data from a nationally-representative sample of pregnant women to examine the extent of HIV testing among pregnant women and the characteristics associated with testing, including access to healthcare. We used data from the combined 2001 and 2002 Behavioral Risk Factor Surveillance System, a nationally-representative telephone-based behavioral survey of adults, aggregated across all states to yield national estimates. Among 4,855 women pregnant at interview we looked at the percentages recently tested and never tested by major populations subgroups and assessed differences using chi-square tests and multiple logistic regression analysis. Pregnant women were tested at a much higher rate than other women of the same age - 54.1% had been tested in the past year compared with 15.4% of non-pregnant women. Categories of pregnant women that were more likely to never have been tested for HIV include those without a health plan or insurance (adjusted odds ratio (AOR): 1.6) and those without a personal doctor (AOR: 1.7). Women with knowledge of methods to prevent perinatal HIV transmission were less likely to have never been tested (AOR: 0.8). Attaining the recommended goal of universal prenatal testing will require attention to women without personal doctors or health insurance.

HIV Testing Among U.S. Women During Prenatal Care: Findings from the 2002 National Survey of Family Growth

OBJECTIVES

To measure progress toward the US Public Health Service recommended goal that HIV screening be part of the routine battery of prenatal tests for all pregnant women, using data from a nationally-representative reproductive health survey.

METHODS

Data from the 2002 National Survey of Family Growth (NSFG) measure self-reported prenatal HIV testing for all women who had a completed pregnancy in the 12 months before interview. We estimated the percentage with a prenatal test for categories defined by major socio-economic groups, HIV risk, knowledge of HIV treatment, and access to health care.

RESULTS

Sixty-nine percent of 748 recently pregnant women reported receiving a prenatal HIV test. The percentage tested was significantly higher for women with incomes below 300% of the poverty level (76%) and women who reported some degree of HIV risk (82%), suggesting that prenatal care providers offer and encourage testing based on perceived risk, even though universal HIV screening is recommended. Testing was also higher among women with knowledge of interventions to prevent perinatal HIV transmission (74%), suggesting that more public information on these treatments might be helpful.

CONCLUSIONS

A national estimate indicates that nearly one in 3 recently pregnant women reported they were not tested for HIV during prenatal care. Studies showing that prenatal testing for other infectious diseases can approach 100% suggest that a similar level of testing is attainable for perinatal HIV screening, particularly if it is incorporated into the routine package of prenatal tests and procedures offered to all pregnant women.

Access to appropriate information on HIV is important in maximizing the acceptance of the antenatal HIV antibody test

The universal HIV antibody testing programme was implemented in Hong Kong in September 2001. A survey on acceptance of the test was conducted in the territory's maternal and child health centres in a two-month period. The response rate was 98.2% and 2,669 valid questionnaires were analysed. Seventy per cent (n=1,825) of the respondents indicated their acceptance of the test. A significant association was noted between clients' acceptance and access to HIV information (adjusted odds ratio (OR)=10.45, 95% confidence interval (CI)=6.33-17.26) by means of posters, pamphlets, videos and group talks. Perceived benefits and health care workers' recommendation were the main reported reasons for acceptance, whereas no or low perceived susceptibility was the main reason for refusal. Acceptance was also positively correlated with level of education (adjusted OR=3.99, 95% CI=2.15-7.43) and HIV knowledge (adjusted OR=3.61, 95% CI=2.19-5.93). A high uptake rate (99.6%) reflects that most had the test done eventually despite some initial uncertainty. It is concluded that access to appropriate HIV information was important to maximize the acceptance of the programme.

Unique challenges to preventing perinatal HIV transmission among Hispanic women in California: results of a needs assessment

To identify rates and factors associated with timely prenatal care (PNC) initiation, HIV test counseling, test offering, and test offer acceptance, we conducted a semistructured survey of a convenience sample of pregnant/recently delivered Hispanic women (n=453, 418 with analyzable data) in four California counties in 2000. Only 68.4% and 43.5% of Hispanic women reported receiving an HIV test offer and counseling, respectively, though 88.8% of those offered a test accepted. After controlling for the effects of age, education, years lived in the United States, health insurance coverage, delivery status, and parity, Hispanic women who initiated prenatal care in the first trimester were 1.7 times more likely to be offered an HIV test and almost 3 times more likely to receive counseling than women with a later prenatal care start or no prenatal care. Factors associated with timely PNC initiation on multivariate analysis were private/HMO insurance (OR=10.7, p < .001), Medi-Cal insurance (OR = 4.32, p < .001), being 25-30 years old (OR = 3.0, p = .008), and completion of high school (OR = 2.07, p = .01). Key opportunities to prevent perinatal HIV transmission are being lost for Hispanic women in California. Interventions to increase timely PNC initiation, and to improve test offering by health care providers, may help to improve counseling and testing rates for this population.

Women's knowledge about treatment to prevent mother-to-child human immunodeficiency virus transmission

OBJECTIVE

To provide national estimates of knowledge about treatments available to reduce mother-to-infant human immunodeficiency virus (HIV) transmission among U.S. women of childbearing age.

METHODS

We used data from 55712 women aged 18 to 44 years who responded to questions on antiretroviral treatment in the 2001 Behavioral Risk Factor Surveillance System. We obtained the percentage of women who correctly answered a question on treatment to prevent mother-to-child transmission of HIV and determined factors independently associated with such knowledge using a multiple logistic regression model.

RESULTS

Overall, the percentage of women who correctly stated that treatment existed to help prevent mother-to-child transmission of HIV was 58.6% (95% confidence interval 57.9, 59.3). In the multiple logistic regression model that controlled for sociodemographics, having correct knowledge about treatment to prevent mother-to-child HIV transmission was independently associated with being black, younger age (18-34 years), college level education, and having been tested for HIV. Current pregnancy was not an independent predictor of having knowledge about the availability of treatment to prevent mother-to-child transmission.

CONCLUSION

Among US women of childbearing age, just over one half had correct knowledge of effective perinatal HIV prevention strategies. Increasing the awareness of these treatments may lead to greater uptake of HIV testing among pregnant women.

Accessing HIV testing and care

With the many recent improvements in the medical management of HIV, the benefits of early detection of the virus have increased. People found to be HIV-positive can be offered immediate referrals for medical care and a comprehensive continuum of services. However, it is estimated that, among the 650,000 to 900,000 seropositive persons in the United States, about one third are unaware of their serostatus. Many of those who are tested for HIV do not return for their results. Among those less likely to return for results are young people and black Americans. Many factors at the individual, system and societal levels negatively impact whether individuals at risk for HIV seek HIV testing in the first place, whether they return for their results, and whether they get appropriate care after they are found to be HIV-positive. Some solutions are offered to improve the identification of new HIV infections. These include social marketing campaigns to encourage individuals to be tested for HIV. Also, more use of the rapid HIV test, which will substantially increase the number of people obtaining their HIV results, is recommended. New computer technologies, such as telemedicine, also have the potential to improve linkages to care for newly diagnosed individuals. In addition, it is essential that HIV care continue to be readily available through the Ryan White Care Act.

Acceptance of HIV testing during prenatal care. Perinatal Guidelines Evaluation Project

OBJECTIVE

The purpose of this study was to assess the factors associated with acceptance of HIV testing during pregnancy on the part of women receiving prenatal care at public clinics.

METHODS

Trained interviewers recruited and interviewed 1,357 women receiving prenatal care at clinics in Florida, Connecticut, and New York City.

RESULTS

Eighty-six percent of participants reported having been tested or having signed a consent form to be tested. Acceptance of testing was found to be related to strong beliefs about the benefits of testing, knowledge about vertical transmission, perceived provider endorsement of testing, and social support. Women who declined testing said they did so because they did not perceive themselves to be at risk for HIV (21%) or they faced administrative difficulties (16%) with some aspect of the testing process (for example, scheduling, limited availability of pre-test counselors).

CONCLUSIONS

Acceptance rates can be increased when women understand the modes of vertical transmission and the role of medication regimens in preventing transmission; believe that prenatal identification of HIV can promote the health of mother and child; and perceive their providers as strongly endorsing testing. These points can be woven into a brief pre-test counseling message and made a routine component of prenatal care.