Routine HIV counseling and testing during antenatal care in Ukraine: A qualitative study of the experiences and perspectives of pregnant women and antenatal care providers

Abstract

Ukraine has one of the highest levels of HIV prevalence in Europe. Provider-initiated HIV testing and counseling (PITC) is routine during antenatal care (ANC) in Ukraine, with nearly all pregnant women receiving HIV testing. National policies state that testing is voluntary, with consent and confidentiality protections, but little is known about actual testing implementation and adherence to these policies. A qualitative study was conducted to explore women's and providers' experiences of HIV testing during ANC, with a focus on consent, counseling, and confidentiality. In-depth interviews were conducted at two urban women's clinics and one semi-urban women's clinic in Donetsk, one of the most HIV-affected regions in Ukraine. Interviews targeted HIV-positive and HIV-negative women recently tested during ANC, as well as health providers involved in administering HIV tests during ANC. Interview analysis revealed gaps between policies and practices, as well as differences in perceptions of aspects of PITC between women and providers. Notable findings included: wide variation in informed consent procedures; providers reporting feeling unequipped to provide adequate counseling; and post-testing practices that may jeopardize patient confidentiality, particularly in the semi-urban site. These findings suggest the need for additional training and support, especially outside major cities, to ensure that HIV testing practices during ANC adhere to Ukrainian policy and global principles regarding PITC.

Factors Associated with Non-disclosure of HIV Status in a Cohort of Childbearing HIV-Positive Women in Ukraine

“…A recent qualitative study of pregnant women in Ukraine highlighted concerns about inadvertent disclosure of a woman's HIV status to other patients in a healthcare setting (and the possibility of this leading to community disclosure), as well as "moral pressure" from clinical staff to disclose HIV status to sexual partners and medical staff (54). Although not practically implemented, there is a legal obligation for HIV-positive people in Ukraine to inform sexual partners of their HIV status, which raises concerns around criminalisation of non-disclosure among patients including pregnant women (54). Healthcare providers reported lack of time and skills to conduct post-test counselling and a need for psychologists to support them in this, but none of the women who received a psychological referral had taken this up (54).…”

“…Although not practically implemented, there is a legal obligation for HIV-positive people in Ukraine to inform sexual partners of their HIV status, which raises concerns around criminalisation of non-disclosure among patients including pregnant women (54). Healthcare providers reported lack of time and skills to conduct post-test counselling and a need for psychologists to support them in this, but none of the women who received a psychological referral had taken this up (54). This may partly reflect the fact that mental health services are widely stigmatised in Ukraine (55).…”

The changing face of women living with HIV in western Ukraine

“…1 Nearly all pregnant women in Ukraine receive HIV testing as part of routine antenatal care. 1,23 This study found a 34-day median delay between diagnosis and registration into care among pregnant women; nonetheless, within the limited and critical time frame of a pregnancy, even this comparatively small delay may have implications for missed opportunities for preventing mother-to-child transmission, especially among women presenting late to antenatal care. However, in 2007, as many as 99% of Ukrainian women received at least one antenatal care visit.…”

Considerations for a Human Rights Impact Assessment of a Population Wide Treatment for HIV Prevention Intervention

“…The right to health includes freedom from involuntary medical treatment, which links closely to consent to HIV testing and immediate treatment. Consent to testing and treatment must be safe guarded even in light of the need to test a large proportion of the population for a population wide treatment as prevention intervention to work . Essential safeguards should include on‐going and continuous training of health workers, monitoring of testing and consent, and information to the community about possible implications of an HIV test and life‐long treatment.…”

“…Consent to testing and treatment must be safe guarded even in light of the need to test a large proportion of the population for a population wide treatment as prevention intervention to work. 55 Essential safeguards should include on-going and continuous training of health workers, monitoring of testing and consent, and information to the community about possible implications of an HIV test and life-long treatment. For this, services will need to be sufficiently resourced with oversight and redress mechanisms in place.…”