Why do antenatal attenders decide to have the HIV antibody test?

Pregnant women's decisions on antenatal HIV screening in Hong Kong

Identification of HIV-infected pregnant women by antenatal screening is crucial to prevent mother-to-child transmission. In Hong Kong, little is known about women's opinions about the screening test. This cross-sectional study examines the decisions of Hong Kong Chinese pregnant women to undergo antenatal HIV screening and the reasons for their choices. Among 191 pregnant women studied, 147 (77.0%) indicated that they would opt for antenatal HIV screening if offered. Of those, 113 (76.9%) would do so for 'the health of their newborns' and 93 (63.3%) for 'their own health'. Fourteen (7.3%) would decline the test, because they have 'one stable sexual partner' (n=9, 64.3%) and believe that 'HIV infection was not their concern' (n=8, 57.1%). Women with a lower educational attainment (adjusted OR=3.77; 95% C.I., 1.12-12.67, p=0.03) were likely to choose antenatal HIV screening. Results of this study are predictive of pregnant women's responses to Hong Kong's newly enacted antenatal HIV screening programme.

Sustaining HIV testing in pregnancy- evaluation of routine offer of HIV testing in three London hospitals over 2 years

This study sets out to examine how routine offers of HIV testing for pregnant women in ante-natal (prenatal) clinics are managed over time. Data was collected over two time periods (2002, 2004) from all women booking clinics at three London hospitals. Data from 3,560 women, comprising 2,710 in 2002 (time 1) and 850 in 2004 (time 2) were gathered. Uptake of HIV testing, demographic variables, HIV-associated risks, pregnancy variables and uptake of other ante-natal tests were monitored. In the later study, details of partner testing and time spent discussing HIV was monitored. HIV test uptake with routine offer (RCT) was high. There was a significant increase in HIV testing over time from 85 to 91% (p<0.0001). In 2004, significantly more women had been previously tested for HIV (25 versus 41%, p<0.0001), more women refused all other ante-natal tests (rubella [0 versus 4% p<0.0001], syphilis [1 versus 5%, p<0.0001], Haemoglobin [1 versus 3%, p<0.0001], Down's syndrome [0 versus 13%, p<0.0001] and hepatitis B [1 versus 5%, p<0.0001]). Significantly less women refused HIV test (15 versus 9%, p<0.0001). Initially, HIV was the most frequently refused test (15%), whereas at time 2 Down's syndrome tests were most frequently declined. At time 1, 2% declined any test. By time 2, 14% of the sample declined any test (p<0.0001). Three percent of women had an established HIV risk at time 1 and 6% at time 2. Women with risk factors were significantly less likely to accept testing at time 2, but not at time 1 or not overall. Multivariable analysis was carried out to look at predictors of opting in and opting out of testing. At time 2 HIV test uptake was more likely if less than 3 min was spent discussing it (chi2=9.3, p=0.002). This information was not available at time 1. HIV testing in ante-natal care can be sustained over time. Challenges for the future relate to complex cases, test declining, ensuring that women with risk factors do not systematically decline and providing skills for midwives or referral pathways to deal with more demanding cases. It has been possible to normalise HIV testing. Women have responded with high HIV test uptake, but are also questioning other tests which were previously routinely offered.

The role of HIV-related knowledge and ethnicity in determining HIV risk perception and willingness to undergo HIV testing among rural women in Burkina Faso

We conducted a random community based survey of 300 young (15-29 years) rural women in Nouna, Burkina Faso. Only one-third of women were aware that a person could have HIV without having symptoms and these women were significantly more likely to classify themselves to be at high risk for getting HIV. Furthermore, multiple partners, Bwaba ethnicity and having mentioned a health worker as a source of HIV information were significantly associated with perceived high personal risk. Perceived willingness to participate in VCT was high (69%). The dissemination of information on the asymptomatic nature of HIV infection could potentially be very important in forming risk perception, awareness, and their willingness to participate in HIV interventions.

Social and ethnic inequalities in the offer and uptake of prenatal screening and diagnosis in the UK: a systematic review

OBJECTIVE

To review studies addressing the question of whether there are social inequalities in either the offer or the uptake of prenatal testing in the UK.

METHOD

Systematic review of studies assessing the offer or uptake of prenatal screening or diagnosis according to social class or ethnic origin. Electronic databases were searched using a strategy developed for a review of inequalities in access to maternity care supplemented with terms specific to prenatal testing. Further papers were identified from reference lists, citation searches and key organizations.

RESULTS

From over 600 identified papers, 41 were potentially relevant. Twenty met the inclusion criteria. The studies included covered screening and/or diagnosis for Down's syndrome, neural tube defects, haemoglobin disorders and HIV. Many studies were limited by small numbers or poor reporting of data and analysis. Six studies reported data on prenatal testing according to women's social class or educational level. None found any significant social inequalities in testing. Some studies suggested that women of South Asian origin might be up to 70% less likely to receive prenatal testing for haemoglobin disorders and Down's syndrome than White women. A small number of studies suggested that South Asian women might be less likely to be offered testing.

CONCLUSIONS

This review provides some evidence of ethnic inequalities in access to prenatal testing. Further research is required to improve our understanding of why testing may not be offered, the reasons for failure to take up testing when offered, and to identify whether there are other social inequalities in access to prenatal testing.

Barriers to universal prenatal HIV testing in 4 US locations in 1997

OBJECTIVES

We determined rates of prenatal HIV testing and investigated barriers to testing.

METHODS

We surveyed 1362 representative parturient women from 7 hospitals in 4 locations of the United States.

RESULTS

Overall, 89.9% of women reported being offered HIV testing and 69.6% reported being tested. Proportions of women not offered testing differed by location (range = 5.2%-16.3%), as did proportions not tested (range = 12.2%-54.4%). Among women who perceived that their clinicians had not recommended testing, 41.7% were tested, compared with 92.8% of women who perceived a strong recommendation (P < .05). Private insurance for prenatal care was also associated with not being tested. Women gave multiple reasons for not being tested, most commonly not being at risk, having been tested recently, and the test's not being offered or recommended, cited by 55.3%, 39.1% and 11.1% of women, respectively.

CONCLUSIONS

Although most parturient women were offered a prenatal HIV test and got tested, testing proportions did not reach national goals and differed significantly by location and payment status. Concern about testing consequences was not a major barrier. Perception of clinicians' recommendations strongly influenced testing. Changing provider practices will be essential to implementing universal prenatal HIV testing.

Voluntary universal antenatal HIV testing

OBJECTIVES

To assess the uptake of universal voluntary named HIV testing of hospital booked antenatal women and to identify behavioural and demographic factors associated with testing. To identify the number of previously undiagnosed women detected by the new policy and to compare prevalence among those testing with that measured by unlinked anonymous monitoring.

DESIGN

Self-completion questionnaire and data abstraction from structured booking forms and virology laboratory records.

SETTING

Central London teaching hospital antenatal clinic.

PARTICIPANTS

One thousand three hundred and seventy-four women booking with a hospital based midwife during the 49 weeks from 27 July 1993 to 1 July 1994.

RESULTS

Before the introduction of the new testing policy fewer than 10 women per year had an HIV test, and during the study this rose to 41% (548/1340). In univariate analysis, caucasian and Mediterranean ethnic origin, fewer previous live births, and more than one lifetime sexual partner were associated with higher uptake of HIV testing. In a multivariate model only the number of previous live births and ethnic origin remained significantly associated with testing. Six women out of 828 (1%) who completed the question about nonprescribed drug use stated that they had injected drugs, and four of these women accepted a test. Two women, both with recognised major risk factors for HIV infection, were diagnosed HIV antibody positive (a prevalence in the tested women of 0.36%). A further three women were already known to be HIV antibody positive. During the 12 months from July 1993 seven women (0.24%) were found to be positive by unlinked anonymous testing.

CONCLUSIONS

The introduction of a universal approach to antenatal HIV testing appears feasible: it increased the uptake of the test and detected previously unrecognised infections. Many women chose not to be tested, however, and cases remained undiagnosed. Further studies are required to examine different models of offering HIV testing, reasons for declining the test, and the cost-benefit of antenatal HIV screening.

Voluntary, named testing for HIV in a community based antenatal clinic: a pilot study

Despite the increasing advantages of identifying HIV infection in pregnant women, only some 12% of HIV positive women attending antenatal clinics in London have been identified by named testing. As virtually all antenatal care will be community based within the next two to three years, we assessed the problems of introducing named HIV testing during pregnancy into the primary care setting. Planning the service took a considerable time and required the production of educational material for both staff and pregnant women and some reorganisation of procedures. Over a one year period an uptake of 44% was noted. Several problems were encountered including an average of 21 minutes needed to give information on AIDS and HIV, an adverse effect on the midwife-mother relationship, and anxiety (affecting both women and midwives). Possible solutions to this difficult problem are discussed.