Correlates of Prenatal HIV Testing in Women with Undocumented Status at Delivery

Webber, Mayris P.; Demas, Penelope; Blaney, Nancy T.; Cohen, Mardge H.; Carter, Rosalind; Lampe, Margaret A.; Jamieson, Denise J.; Maupin, Robert; Nesheim, Steven; Bulterys, Marc

doi:10.1007/s10995-007-0257-5

Cited by 7 publications

(2 citation statements)

References 14 publications

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“…Poor documentation of HIV orders, test results, and reasons for declining HIV screening tests leads to overestimation of the number of cases in which HIV screening during pregnancy was not followed according to guidelines and state law. In fact, multiple studies have shown poor documentation of HIV status in prenatal records both before and after the CDC issued its recommendations regarding HIV screening in pregnancy in 2006 [16]- [20]. Other limitations of this study that overestimate the number of cases in which HIV screening in pregnancy was not followed according to guidelines include inadequate prenatal care, whereby there are too few visits for the provider to order an HIV screening test; poor patient compliance with scheduled prenatal and laboratory visits; delivery early in the third trimester before repeat HIV screening could be completed; and providers following previous trimester definitions when ordering HIV screening tests (for example, the second trimester spanning from 13 weeks 0 days to 23 weeks 6 days, and the third trimester beginning at 24 weeks).…”

Section: Discussionmentioning

confidence: 99%

HIV Screening During Pregnancy in a U.S. HIV Epicenter

Szlachta-McGinn

Aserlind

Duthely

et al. 2020

Infectious Diseases in Obstetrics and Gynecology

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Background. The CDC and ACOG have issued guidelines for HIV screening in pregnancy for patients living in areas with high prevalence of HIV in order to minimize perinatal vertical transmission. There is a lack of data examining providers’ compliance with these guidelines in at-risk patient populations in the United States. Objective. To evaluate if HIV screening in pregnant women was performed according to guidelines at a large, urban, tertiary care medical center in South Florida. Study Design. A retrospective review was performed on 1270 prenatal and intrapartum records from women who delivered a live infant in 2015 at a single institution. Demographic and outcome data were chart abstracted and analyzed using arithmetic means and standard deviations. Results. Of the 1270 patients who met inclusion criteria, 1090 patients initiated prenatal care in the first or second trimester and delivered in the third trimester. 1000 (91.7%) patients were screened in the first or second trimester; however, only 822 (82.2%) of these were retested in the third trimester during prenatal care. Among the 178 patients lacking a third trimester test, 159 (89.3%) received rapid HIV testing upon admission for delivery. Of the 1090 patients who initiated prenatal care in the first or second trimester and delivered in the third trimester, 982 (90.1%) were screened in accordance with recommended guidelines. Of the 1270 patients initiating care in any trimester, 24 (1.9%) had no documented prenatal HIV test during prenatal care, however 22 (91.7%) had a rapid HIV test on admission for delivery. Two (0.16%) patients were not tested prenatally or prior to delivery. Conclusion. Despite 99.8% of women having at least one HIV screening test during pregnancy, there is room for improvement in routine prenatal screening in both early pregnancy and third trimester prior to onset of labor in this high-risk population.

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Section: Discussionmentioning

confidence: 99%

HIV Screening During Pregnancy in a U.S. HIV Epicenter

Szlachta-McGinn

Aserlind

Duthely

et al. 2020

Infectious Diseases in Obstetrics and Gynecology

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“…However, evidence suggests that there are ongoing barriers to universal testing related to: (1) individual patient factors, including low perceived risk for HIV, race, socioeconomic status, and confidentiality concerns; (2) provider factors, such as the need to improve knowledge, increase the rates at which they ask about or recommend testing, and strengthen testing practice patterns; and (3) site-related factors, including the need to expand testing in non-traditional settings [6–10]. There is limited information regarding women’s specific concerns about prenatal HIV testing and how these concerns can be most effectively addressed [4, 11–13].…”

Section: Introductionmentioning

confidence: 99%

Routine Prenatal HIV Testing: Women’s Concerns and Their Strategies for Addressing Concerns

Rothpletz‐Puglia¹,

Storm²,

Burr³

et al. 2011

Matern Child Health J

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The purpose of this exploratory study was to solicit women’s opinions about the process of routine prenatal HIV testing to identify strategies for routine testing that will address women’s concerns, increase their level of comfort with testing, and support universal prenatal HIV testing. A convenience sample of English-speaking women between 18 and 45 years of age who were HIV-negative or of unknown HIV status were recruited for focus groups at four diverse community sites in four states. Focus group discussion questions addressed health care provider approaches and actions that would make a woman feel more comfortable with the process of routine prenatal HIV testing. Twenty-five women agreed to participate; most women (64%) were of Black, non-Hispanic race/ethnicity; 44% were 25–34 years of age. Thematic analysis of women’s concerns about routine prenatal HIV testing fell into the following categories: fear, protecting the baby, protecting the woman, confidentiality, and stigma. Women’s strategies for addressing these concerns were related to themes of education and information, normalizing HIV testing, patient–provider relationships, systems, and private communication. Participants offered numerous insightful and practical suggestions for addressing their concerns thereby supporting universal routine prenatal HIV testing. The themes that arose in this study support the conclusion that women will be more comfortable with routine prenatal HIV testing if they are fully informed and knowledgeable about the rationale for HIV testing during pregnancy and their right to decline, and if testing is carried out in a confidential and supportive health care environment.

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Factors Associated with Declining a Rapid Human Immunodeficiency Virus Test in Labor and Delivery

Tan

Lampe

Danner

et al. 2010

Matern Child Health J

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The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists recommend routine rapid HIV testing in labor and delivery (L&D) for women with undocumented HIV status using an opt-out approach. Identifying factors associated with declining a rapid HIV test in L&D will be helpful in developing strategies to improve rapid HIV testing uptake. Data from the Mother-Infant Rapid Intervention at Delivery study were analyzed. Women ≥24 weeks gestation, in labor, with undocumented HIV status were offered rapid HIV testing using informed consent. Women who declined rapid HIV testing (decliners) but agreed to be interviewed were compared to women who accepted testing (acceptors). 102 decliners and 478 acceptors met inclusion criteria for analysis. Decliners of rapid HIV testing were more likely to have had prenatal care (PNC), after adjusting for age, Hispanic ethnicity, high-school education and city of enrollment (adjusted OR 2.4, 95% CI 1.06-5.58). Having had PNC was collinear with prior HIV education and previous offer of an HIV test during the current pregnancy, so these factors were not part of the model. During PNC, standard informed consent may involve discussions that negatively affect later uptake of testing in L&D. Therefore an opt-out approach to testing may improve testing rates. Furthermore, decliners may have felt that testing in L&D was redundant because of previous testing during PNC; however, if previous testing occurred, this was undocumented at L&D. Documentation and timely communication of HIV status is critical to provide appropriate HIV prophylaxis.

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Correlates of Prenatal HIV Testing in Women with Undocumented Status at Delivery

Abstract: Improved documentation of prenatal test results, expanded prenatal testing in non-traditional settings like EDs, and routine voluntary "opt-out" testing during pregnancy may further reduce perinatal HIV transmission.

Cited by 7 publications

References 14 publications

HIV Screening During Pregnancy in a U.S. HIV Epicenter

HIV Screening During Pregnancy in a U.S. HIV Epicenter

Routine Prenatal HIV Testing: Women’s Concerns and Their Strategies for Addressing Concerns

Factors Associated with Declining a Rapid Human Immunodeficiency Virus Test in Labor and Delivery

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