Prenatal HIV counseling,testing, and antiretroviral prophylaxis by obstetric and family medicine providers in Alabama

BACKGROUND: The study reported here assessed the implementation of recommendations for routine universal prenatal counseling and voluntary HIV testing among Alabama physicians who provide prenatal care and determined factors associated with noncompliance. METHODS: Voluntary, confidential mailed survey of obstetrics and family medicine practitioners. RESULTS: Of the 138 physicians who responded to a mailed survey in Alabama, 17 (12.3%) indicated that they did not offer universal HIV counseling and testing to pregnant women. Factors associated with failure to offer universal HIV counseling and testing included having more than 50% of patients refuse HIV counseling and testing when offered and never knowingly having given prenatal/perinatal care to women with HIV. Low/medium familiarity with the US Public Health Service recommendations for perinatal zidovudine use to reduce HIV transmission and physician specialty are also suggested as predictors of not offering universal testing. CONCLUSIONS: Despite the well-established benefits of antiretroviral prophylaxis to prevent vertical transmission of HIV, some physicians in Alabama have been slow to adopt universal testing of their pregnant patients for HIV in the prenatal period. Practitioner education is as important as patient education in eliminating pediatric HIV in the Deep South.     

Perception of voluntary screening for paediatric HIV and response to post-test counselling by Nigerian parents

Nigeria may be taken to represent countries with an evolving HIV/AIDS epidemic. With particular reference to paediatric HIV, the voluntary testing of young children and their parents may provide an important entry point for the institution of control measures. However, there is a paucity of knowledge about how individuals perceive voluntary testing. This knowledge is important to the development of guidelines for counselling. To reduce this gap, 258 parents of hospitalized children (> 1 month to 15 years of age) were interviewed using a structured questionnaire. In addition, to complement the data, four examples of seropositive mother's responses during post-test counselling are presented and analyzed. In the survey, 223 (86%) parents were HIV/AIDS aware but only 88 (39%) of these parents could describe one or more route(s) of transmission and none described vertical transmission. Among the respondents, 153 (62%) of 248 would consent to the screening of self, and 195 (85%) of 230 to the screening of a hospitalized child if based on his/her clinical condition. Perceptions of good health and lack of exposure, and despair owing to lack of a specific treatment, were the common reasons for refusing consent. These represent some of the issues which would need to be addressed to increase the acceptance of voluntary testing. The fear of a break up of families with seropositive mothers but seronegative fathers was a major concern expressed during post-test counselling. HIV-discordance among couples may be frequent and should be considered in the formulation of policies on counselling and voluntary testing.     

HIV screening in pregnant women

Abstract. The following recommendations are made for prenatal screening for HIV infection 1) Routine voluntary screening for HIV infection in all pregnant women is feasible and worthwhile. 2) Every seropositive result should be repeated for confirmation before coming to a definititve conclusion to avoid a misdiagnosis. 3) Fetal blood sampling in the mid-trimester for PCR and p24 antigen assay seems inappropriate as a diagnostic tool for in utero HIV infection of the HIV seropositive pregnant women as the infection mostly occurs after this time. 4) Routine screening of seronegative pregnant women should be repeated during the third trimester to detect seroconversion since this offers a chance for antiretroviral administration to the seroconverted pregnant women for reduction of perinatal transmission. 5) There should be available the appropriate back up services for seropositive pregnant women. There is sufficient evidence indicating a higher vertical HIV-1 transmission rate in the last trimester and during labour compared with the first and second trimesters. Antiretroviral therapy either single or in combination given to the mother during the last trimester and delivery can reduce the viral load in the maternal circulation. Vertical HIV-1 transmission during delivery can be minimized by appropriate timing and route of delivery. Elective Cesarean section before the onset of labour with an intact bag of forewaters provides the least mother-to-fetus microtransfusion compared to other modes of delivery. Since an effective combination of HIV-1 immunoglobulin and HIV-1 vaccine given to the HIV-1 exposed newborns to prevent HIV-1 transmission similar to the viral hepatitis B model is not firmly established at present, postexposure antiretroviral prophylaxis and nonbreast-feeding are advocated for infants born from the HIV-1 infected mothers. In cases of advanced stage of maternal HIV-1 infection, and in developing areas where malnutrition prevails, an adequate supply of essential micronutrients is proposed as an adjunctive measure to reduce HIV-1 perinatal transmission.     

Prevention of mother-to-child transmission of HIV in Africa: successes and challenges in scaling-up a nevirapine-based program in Lusaka,Zambia

BACKGROUND: Nearly half of perinatal HIV infection is preventable with nevirapine (NVP), which has transformed the ability to confront this transmission route in resource-limited settings. METHODS: A NVP-based perinatal HIV prevention program initiated in Lusaka, Zambia in November 2001. RESULTS: The first 12 months cost US$221 000 and enabled 178 district health employees to be trained in voluntary counseling and testing: 17 263 pregnant women were counseled for HIV, 12 438 (72%) were tested, and 2924 (24%) were found to be infected with HIV. NVP has been taken by 1654 (57%) mothers and 1157 (40%) babies. It is estimated that at least 190 infants have been spared HIV infection (11 per 1000 counseled women or 65 per 1000 identified HIV-infected women). CONCLUSIONS: Prevention of mother-to-child HIV transmission is feasible and cost effective in resource-limited settings. In Lusaka, thousands of women have received voluntary counseling and testing and NVP therapy under the present scheme. Patient attrition and non-adherence represented a major source of program inefficiency, which requires to be systematically addressed.     

Attitudes towards prenatal HIV testing and treatment among pregnant women in southern India

During June and July 1999, oral interviews were conducted on 666 women seeking prenatal care at 9 medical facilities in Chennai and Mysore, India, to assess their attitudes towards prenatal HIV testing and antiretroviral prophylaxis for preventing perinatal HIV transmission if needed. Seventy-eight per cent were aware of the risk of perinatal HIV transmission and 36% knew that intervention could reduce the chances of such transmission. Eighty-six per cent would agree to undergo prenatal HIV testing but only 21% of all respondents would make this decision independently while 46% said their husband would have to decide. Of those women who would not agree to testing, 21% would agree if testing were compulsory. Ninety-seven per cent of respondents would undergo antiretroviral prophylaxis to prevent vertical transmission, and 94% would consider alternatives to breastfeeding if HIV positive. Considering its widespread acceptability, prenatal voluntary counselling and testing may be an affordable method of HIV prevention for this population.     

Report from Geneva: women and HIV

The 12th World AIDS Conference in Geneva received reports on the efficacy of AZT in reducing HIV transmission between mother and infant, as well as other risk factors for transmission. Two studies revealed that a short-course of AZT treatment can reduce perinatal transmission. Two other large studies showed that incorporation of prenatal AZT into clinical practice has dramatic benefits in reducing HIV transmission. Most publicized was the data from several studies which show that a Cesarean section performed before the onset of labor or rupture of membranes, further reduces the risk of perinatal transmission. Researchers also provided information indicating that breastfeeding should be avoided when the mother is HIV-infected, that the presence of HIV may reduce a pregnant woman's ability to control the perinatal transmission of malaria, and that bacterial vaginosis was associated with HIV seroconversion during pregnancy and increased perinatal transmission. Finally, Geneva produced several studies reporting gender differences in viral load that have implications for when to begin antiretroviral therapy, that the genital tract represents a distinct reservoir of HIV infection, and that HIV-infected women were showing increased rates of lower genital tract neoplasia, which correlated with evolving immunosuppression.     

Integrating prevention of mother-to-child HIV transmission into antenatal care: learning from the experiences of women in South Africa

In 1999, for the first time in South Africa, a Mother-to-Child HIV Transmission (MTCT) prevention programme was implemented at the routine primary care level and not as part of a research protocol. A total of 264 women attending prenatal care in these clinics were interviewed in Xhosa using a standardized questionnaire. All had been offered HIV testing, and 95% had accepted. Women who had not been tested were four times more likely to believe that in the community families reject HIV-positive women (p<0.005). Of women who tested, 19% were HIV positive and 83% had told their partner that they had taken the test. HIV-positive women who had not disclosed testing to their partners were three times more likely to believe that, in the community, partners are violent towards HIV-positive women (p<0.005); 86% stated that they would have taken AZT if found to be HIV positive. Only 11% considered that the use of formula feeding indicated that a woman was HIV positive. In conclusion, routine prenatal HIV testing and interventions to reduce perinatal HIV transmission are acceptable to the majority of women in a South African urban township, despite an awareness of discrimination in the community towards HIV-positive women.     

Frequent detection of acute HIV infection in pregnant women

BACKGROUND: Universal prenatal HIV antibody testing, which does not detect acute HIV, is standard for pregnant women in the United States. Unrecognized HIV acquisition during pregnancy may result in higher rates of perinatal transmission. OBJECTIVE: To determine the prevalence of acute (antibody-negative) HIV infection in pregnant women and to assess the potential for prompt initiation of antiretroviral therapy to prevent perinatal transmission. METHODS: From 1 November 2002 to 30 April 2005, all publicly funded HIV testing sites participated in North Carolina's Screening and Tracing Active Transmission (STAT) Program, which retested all specimens that were HIV antibody negative for HIV RNA using specimen pooling. All patients with acute HIV infection were immediately traced for evaluation, confirmatory testing, counseling, and referral services. For this study, all pregnant women with acute HIV were immediately initiated onto antiretroviral therapy and followed prospectively for pregnancy outcomes. RESULTS: During the study period, 443 women were HIV positive by antibody testing; 15 were HIV antibody negative but positive by RNA assay and of these five were pregnant at the time of testing. The pregnant women received antiretroviral drugs and delivered HIV-uninfected infants. Maternal testing records of all six HIV-infected infants born in North Carolina showed three mothers with chronic HIV infection and three HIV antibody negative at private prenatal testing facilities. CONCLUSIONS: In resource-rich settings, a substantial proportion of residual perinatal transmission may be from HIV acquisition during pregnancy. Standard antibody tests miss acute HIV infection and so algorithms that include pooled HIV RNA testing may improve its detection and represent a further opportunity to prevent perinatal transmission.     

There's no excuse for babies to be born today infected with HIV

Vertical HIV transmission from mother to child is almost entirely preventable with prenatal screening and treatment, but most of the 15,000 infected children in the United States were infected by their mothers. Of those, many will die before they reach the age of 13. Clinicians are calling for universal HIV testing for pregnant women and the administration of antiretroviral treatment either during labor or soon after the baby's birth. Even with universal testing and treatment, there will still be some instances of breakthrough transmission, but the rate of infection for babies would be much lower. A chart shows the percentage of mothers, arranged by states, who discussed HIV testing with their health care provider. Rapid testing in combination with Zidovudine (AZT) treatment has lowered HIV transmission rates by 38 percent in breast-feeding populations and 50 percent in non-breast-feeding populations. The benefits of Nevirapine therapy are discussed.     

Prevention of Mother-to-Child Transmission of HIV: Compliance with the Recommendations of the Brazilian National STD/AIDS Control Program for Prenatal and Perinatal HIV Testing in Porto Alegre, Brazil

In order to benefit from antiretroviral therapy, pregnant women infected with HIV must be tested and diagnosed. Not infrequently, however, women present in labor without prior prenatal care and are thus unable to benefit fully from HIV testing and, if infected, antiretroviral therapy. In this study we evaluated the need for rapid perinatal HIV testing for untested mothers presenting in labor in a public maternal–child hospital that provides care for metropolitan Porto Alegre, Brazil, and potentially modifiable risk factors for noncompliance with national recommendations. We surveyed a consecutive sample of women who gave birth at Hospital Materno–Infantil Presidente Vargas (Presidente Vargas Mother-and-child Hospital) in August–October 2001and administered a structured questionnaire to consenting participants. The questionnaire consisted of demographic data, information on health-seeking behavior, knowledge of HIV infection, and testing during pregnancy. We confirmed information on HIV testing, syphilis, and hepatitis B by examination of the patient's prenatal records. We also obtained data regarding laboratory testing and treatment during labor and delivery (e.g., HIV testing, antiretroviral treatment, and suppression of lactation) from hospital inpatient charts. Of 214 eligible participants, 209 (98%) agreed to participate in the study. Overall 173 (83%) of the 209 participants had had a previous HIV test and 36 (17%) had not. Women with fewer pregnancies were more likely to have been tested (p = .017), as were women with lower family incomes (p = .007). No women had received rapid tests in the delivery room. Of the 209 participants, 201 (96%) had had at least one prenatal visit and 169 (81%) had had three or more visits; 12 (6%) of these reported that they had not been offered an HIV test, 5 (2%) did not know if testing had been offered or not, and 191 (95%) reported that they had been offered a test. We were able to obtain prenatal records for 190 (95%) of the 201participants who had received prenatal care. HIV testing was not mentioned in 9% of charts. Results of syphilis tests were recorded on prenatal records or hospital charts for 167 (80%)participants, and results of hepatitis B surface antigen were found for 93 (45%). Women who to 30pchad had three or more prenatal visits were significantly more likely to have been tested for to 30pcHIV (OR 46.96, 95% CI, 15.92–144.85, .0001), syphilis (OR 31.64, 95% CI, 11.81–87.42, p < .0001) or HBsAg (OR, 4.88, 95% CI, 1.91–12.99, p < .0001) than women who had had two prenatal visits or fewer. Our study showed shown that in 12% of the pregnancies included in our sample national recommendations for prenatal or perinatal testing were not followed, and in an additional 5%, HIV testing, though offered, was not obtained. These women could potentially have benefited from rapid HIV testing. As knowledge of HIV and risk factors for transmission were almost universal in our sample, we believe that the passive health-seeking behavior we observed may offer an opportunity for targeting new efforts to promote the importance of prenatal care and prenatal diagnosis of HIV.     

Factors Associated with Refusal of Rapid HIV Testing in an Emergency Department

HIV screening studies in the emergency department (ED) have demonstrated rates of HIV test refusal ranging from 40–67%. This study aimed to determine the factors associated with refusal to undergo routine rapid HIV testing in an academic ED in Boston. HIV counselors offered routine testing to 1,959 patients; almost one-third of patients (29%) refused. Data from a self-administered survey were used to determine independent correlates of HIV testing refusal. In multivariate analysis, women and patients with annual household incomes of $50,000 or more were more likely to refuse testing, as were those who reported not engaging in HIV risk behaviors, those previously HIV tested and those who did not perceive a need for testing. Enrollment during morning hours was also associated with an increased risk of refusal. Increased educational efforts to convey the rationale and benefits of universal screening may improve testing uptake among these groups.     

IOM: Make prenatal HIV testing part of routine care. Institute of Medicine

The Institute of Medicine (IOM) has recommended that universal HIV testing be a part of routine prenatal care. Making the screening universally available could help eliminate the stigma attached to AIDS testing and would allow more at-risk mothers to be treated, reducing the incidence of perinatal transmission. It would also be cost-effective, as the benefits of early treatment with antiretrovirals far outweigh the cost of prenatal testing. The American College of Obstetricians and Gynecologists (ACOG) originally opposed routine prenatal HIV testing because they believed it interfered with the relationship between physician and patient. ACOG is now officially endorsing the IOM recommendations.     

Prenatal Screening for HIV in Nova Scotia: Survey of Postpartum Women and Audit of Current Prenatal Screening Practices.

BACKGROUND: Current guidelines for screening for HIV infections in Nova Scotia recommend an opt-in approach in which patients are counselled and consent to testing. The objectives of the present study were to measure adherence to these recommendations, to explore women's knowledge, attitudes, beliefs and behaviours concerning HIV screening, and to compare these results with prenatal screening practices for rubella, hepatitis B and group B streptococcus. METHODS: All women who gave birth consecutively during a seven-week period were recruited. Study participants were interviewed to determine their knowledge, attitudes and beliefs concerning prenatal screening. Hospital and laboratory records were reviewed for information concerning prenatal screening and perinatal treatment to audit screening practices. RESULTS: A total of 279 patients were enrolled in the study, representing 58% of those eligible. The HIV screening rate was 72%, compared with 95% for rubella, 89% for hepatitis B and 24% for group B streptococcus. Of the participants tested for HIV, 80% were aware of being tested. Of all the study participants, 17% indicated having received pretest counselling about HIV, 56% volunteered to be tested for HIV, 78% received the test results, and 3.8% received post-test counselling. More participants preferred an opt-out approach to HIV screening (50%), where testing is routinely performed on everyone, rather than the opt-in approach (43%). Participants displayed a similar preference for screening for the other infections. INTERPRETATION: HIV prenatal testing rates in Nova Scotia are comparable with those of other provinces that recommend an opt-in approach, but are lower than testing rates for opt-out programs. Most study participants were not screened using the recommended opt-in approach.     

HIV infection among pregnant women in Bobo-Dioulasso, Burkina Faso: comparison of voluntary and blinded seroprevalence estimates

The objective of our study was to estimate the prevalence of HIV infection among pregnant women in Bobo-Dioulasso (Burkina Faso) according to 2 survey methods. Unlinked anonymous HIV screening was performed among women attending 2 antenatal clinics. Voluntary and confidential HIV counselling and testing were offered to women attending 2 other antenatal clinics in the same time period, September-October 1996. Voluntary HIV testing was performed in the context of a clinical trial on mother-to-child transmission of HIV (ANRS 049 clinical trial) with an acceptance rate of HIV testing of 93%. The first survey recruited 200 women and the second, 424. The mean age (24.6 years vs 24.8 years) and the mean number of pregnancies (3.1 vs 3.3) of women were comparable, in the 2 studies (P=0.69 and P=0.26, respectively). Prevalence of HIV infection in the blinded survey was estimated at 10.0% (95% confidence interval (CI): 6.4-15.2), while it was 9.4% (95% CI: 6.9-12.7) in the voluntary HIV screening programme. These 2 estimates were not statistically different (P=0.82). In the voluntary screening study, the prevalence of HIV infection was significantly different between age groups 15-24 years and 25-49 years (13.9% vs 4.5%, P < 0.001). In the age group 25-49 years, the prevalence of HIV infection estimated in the blinded study and in the voluntary screening study were significantly different (10.5% vs 4.5%, P=0.04) suggesting a potential participation bias among pregnant women of older age in the voluntary, confidential HIV screening group. In conclusion, for the purpose of HIV surveillance, the most reliable method for HIV prevalence remains the unlinked, anonymous testing.     

Human immunodeficiency virus surveillance at a sexually transmitted disease clinic in Copenhagen

During four study periods, each of 3-4 weeks' duration in 1987 and 1988, all patients attending the Copenhagen outpatient Venereal Disease Clinic were encouraged to have a test for human immunodeficiency virus (HIV) antibody. Anonymous testing or testing for research purposes only without any data was also offered. Patients known to be HIV antibody-positive were not re-tested. A total of 1753 patients (1118 men, 635 women) were counselled and testing recommended. Testing was refused by 255 patients, 57 of whom had been tested (all negative) within the previous 3 months. HIV serology was therefore unknown in 11.7% (198 of 1696 persons), including 120 of 922 heterosexual men (13%), 16 of 159 homo/bisexual men (10%) and 62 of 615 women (10%). There was no substantial difference between the four study periods in the numbers refusing the test. Sixteen of the 1498 patients tested were HIV antibody-positive, including one woman and 3 men with a history of intravenous drug abuse and 11 homo/bisexual men; one heterosexual man with HIV antibodies had no known risk behaviour. It is concluded that HIV testing with informed consent at a sexually transmitted disease clinic will not include all persons, and therefore will not exclude a self-selection bias. Surveillance studies using unlinked HIV testing are therefore necessary and it is recommended that they should be performed in Denmark. In this study, unlinked HIV testing of the serum specimens taken for syphilis serology would have decreased the percentage of 'non-attenders' from 12.4% to 0.8% during the final study period.     

Prevalence of HIV among pregnant women in Dundee 1988-1997: evidence to gauge the effectiveness of HIV prevention measures

OBJECTIVES: During November 1988-July 1990, an HIV prevalence survey of pregnant women in Dundee, which used a combined voluntary diagnostic testing and voluntary unlinked anonymous approach, revealed a rate of 0.3%, the highest recorded prevalence among such a population in the U.K. at the time. To determine if, and why, any changes in HIV prevalence had occurred during the early to mid 1990s, further studies were conducted. METHODS: During January 1993-December 1997, antenatal patients of, and women undergoing therapeutic termination of pregnancy at, Ninewells Hospital, Dundee, were offered a diagnostic HIV antibody test. For those declining, residual sera from rubella specimens were tested for HIV antibodies using an unlinked anonymous approach which did not necessitate the securement of informed consent. Information about injecting drug use was obtained from all women and linked to their HIV test results. RESULTS: For all pregnant women, a significant decline in HIV prevalence (P<0.05) from 0.3% (19/6228) during 1988-1990 to 0.12% (22/17899) during 1993-1997 was observed. For those who injected drugs, prevalence decreased significantly (P<0.05) from 27.5% (11/40) to 7% (6/85), while among women who had never injected drugs prevalence decreased slightly, but not significantly (P>0.05), from 0.13% (8/6188) to 0.09% (16/17814).Prevalence in the non-injectors who reported no sexual intercourse with an injector was low at 0.04% (8/17682) during 1993-1997. No significant trends in HIV prevalence were seen over the 5 years up to 1997. CONCLUSION: The decline in HIV prevalence among pregnant women in Dundee during the early to mid-1990s can be explained predominantly by the control of HIV transmission among the city's injectors, and from them to the wider heterosexual population. It is likely that interventions designed to reduce needle/syringe sharing among injectors have been successful. It is imperative that the preventive effort is not allowed to be weakened.     

Beneficial Effects of Offering Prenatal HIV Counselling and Testing on Developing a HIV Preventive Attitude among Couples. Abidjan, 2002–2005

Prenatal HIV counselling and testing is mainly an entry-point to the prevention of mother-to-child transmission of HIV, but it may also play an important role in triggering the development of spousal communication about HIV and sexual risks and thus the adoption of a preventive attitude. In Abidjan, Côte d’Ivoire, we investigated couple communication on STIs and HIV, male partner HIV-testing and condom use at sex resumption after delivery among three groups of pregnant women who were offered prenatal counselling and HIV testing: HIV-infected women, uninfected women, and women who refused HIV-testing. The proportion of women who discussed STIs with their regular partner greatly increased after prenatal HIV counselling and testing in all three groups, irrespective of the women’s serostatus and even in the case of test refusal. Spousal communication was related to more frequent male partner HIV-testing and condom use. Prenatal HIV counselling and testing proposal appears to be an efficient tool to sensitize women and their partner to safer sexual practices.     

Prenatal HIV counseling and testing in California: women's experiences and providers' practices.

Two concurrent surveys were conducted in four California counties to compare the prenatal HIV counseling and voluntary testing (C&VT) experiences of women with the self-reported practices of prenatal care providers. Participants were 850 women currently or recently receiving prenatal care and 254 providers. Although 79.9% of women reported being offered an HIV test during a prenatal visit, only 56.2% said they were told about the risks and benefits of taking an HIV test. Almost all providers (98.4%) indicated they offer an HIV test, and 76.8% reported offering counseling, to every patient. One third of the women (65.9%) knew that treatment exists for reducing the chance of prenatal transmission of HIV, and 78.7% of women said they were more likely to be tested given knowledge of such therapy. Women may have underreported prenatal C&VT because providers spend insufficient time discussing related issues or because C&VT information is not presented in a way that is relevant to all patients.     

HIV testing of male partners of pregnant women in Porto Alegre,Brazil: A potential strategy for reduction of HIV seroconversion during pregnancy

Pregnant women have a significantly higher risk of HIV acquisition during gestation than their non-pregnant counterparts due to behavioral and biological factors. Acute seroconversion during gestation results in increased HIV mother-to-child transmission rates and has been identified as a major public health challenge. In order to address potential HIV seroconversion in our pregnant patients, we conducted a prospective cohort study to evaluate the acceptability of offering HIV testing to sexual partners of HIV-negative pregnant women receiving antenatal care at two hospitals in Porto Alegre, Brazil. Over a 14-month study period, HIV-negative pregnant women at two hospital-based clinic sites were encouraged to bring their stable sexual partner for HIV voluntary counseling and testing during prenatal care. Women were re-interviewed following delivery to measure success of the intervention. Of the 1223 HIV-negative pregnant women enrolled in the study, 663 (54%) of their male sexual partners received HIV testing during antenatal care and 4 (0.6%) were diagnosed with HIV infection. A total of 645 women were interviewed at the time of delivery, with 620 (97%) confirming that HIV testing was suggested to their partner. The most common reason provided by women as to why partners did not come for testing was work (69%) and lack of perceived risk (14%). Independent predictors of successful partner testing included being white (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.18–2.12), married (OR 1.78, 95% CI 1.08–2.94), having an older age of sexual debut (OR 0.94, 95% CI 0.9–0.98), and being recruited at Hospital Conceiçao (OR 2.1, 95% CI 1.52–2.88). We conclude that HIV partner testing during prenatal care is acceptable, rendering this intervention attractive to public health programs targeting prevention of sexually transmitted infections.     

Refusing HIV testing in an urgent care setting: results from the "Think HIV" program

Efforts to increase HIV case identification through routine, voluntary HIV testing are hindered by high refusal rates. Our objective was to identify patients most likely to refuse routine HIV testing. We developed a new HIV testing program at four Massachusetts urgent care centers. Patients were asked if they were interested in routine HIV testing. We performed analyses to assess differences in characteristics between those who refused testing and those who accepted it. Data were available for 9129/10,354 (88%) patients offered routine HIV testing from January to December 2002. Of these 9129 patients, 67% refused testing. In the crude analysis, HIV test refusal was associated with female gender, white race, older age, and higher educational level. In multivariate analysis, non-English-speaking patients who were Hispanic, Haitian, and other race were more likely to refuse testing than their English-speaking counterparts. Among all patients, "not at risk" and "already tested" were the most common reasons for test refusal. Two thirds of patients refused routine HIV testing when it was offered in a statewide urgent care-based program. If routine HIV testing programs are to be successful, strategies must be developed to increase HIV test acceptance among patients most likely to refrain from testing.