Routine offer of antenatal HIV testing (“opt-out” approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe

Abstract

Objective To assess the impact of routine antenatal HIV testing for preventing mother-to-child transmission of HIV (PMTCT) in urban Zimbabwe. Methods Community counsellors were trained in routine HIV testing policy using a specific training module from June 2005 through November 2005. Key outcomes during the first 6 months of routine testing were compared with the prior 6-month "opt-in" period, and clients were interviewed. Findings Of the 4551 women presenting for antenatal care during the first 6 months of routine HIV testing, 4547 (99.9%) were tested for HIV compared with 3058 (65%) of 4700 women during the last 6 months of the opt-in testing (P < 0.001), with a corresponding increase in the numbers of HIV-infected women identified antenatally (926 compared with 513, P < 0.001). During routine testing, more HIV-infected women collected results compared to the opt-in testing (908 compared with 487, P < 0.001) resulting in a significant increase in deliveries by HIV-infected women (256 compared with 186, P = 0.001); more mother/infant pairs received antiretroviral prophylaxis (n = 256) compared to the opt-in testing (n = 185); and more mother/infant pairs followed up at clinics (105 compared with 49, P = 0.002). Women were satisfied with counselling services and most (89%) stated that offering routine testing is helpful. HIV-infected women reported low levels of spousal abuse and other adverse social consequences.

Women’s willingness to be tested for human immunodeficiency virus during pregnancy: A review

“…In a study by Kizito et al [33] , of a total of 20738 women who received prenatal services at Entebbe Hospital in Uganda from May 2002 to January 2006, 62.8% accepted testing for HIV. In contrast, in a study by Chandisarewa et al [34] , following the initiation of routine HIV testing in urban Zimbabwe, 99.9% were tested for HIV. These results may not have been representative of the total population of pregnant women in these countries [33,34] .…”

“…In contrast, in a study by Chandisarewa et al [34] , following the initiation of routine HIV testing in urban Zimbabwe, 99.9% were tested for HIV. These results may not have been representative of the total population of pregnant women in these countries [33,34] . Despite the high reported testing rates, as long as HIV testing coverage of pregnant women is not 100%, every pregnant woman with unknown HIV-status potentially endangers the health of her future child and the health of future generations.…”

“…The CDC reviewed HIV testing rates among pregnant women and found that opt-out testing resulted in higher rates of testing (71%-98%) than the opt-in approach (25%-83%). The opt-out approach has been shown to be more successful in terms of testing rates than the opt-in approach in sub-Saharan Africa [6,34,[46][47][48] . It has been suggested that the opt-out approach destigmatizes the test, which might explain higher testing rates when the opt-out approach is applied [34] .…”

“…The opt-out approach has been shown to be more successful in terms of testing rates than the opt-in approach in sub-Saharan Africa [6,34,[46][47][48] . It has been suggested that the opt-out approach destigmatizes the test, which might explain higher testing rates when the opt-out approach is applied [34] . It is also possible that the opt-out approach merely requires less effort on the part of the woman to be tested.…”

Incidence of Nephropathy in HIV Infected Patients Receiving Highly Active Antiretroviral Therapy at Newlands Clinic: A Retrospective Study

“…The younger age of female participants compared to males might in part be explained by the national Prevention of Mother to Child Transmission (PMTCT) program which provides routine Provider Initiated HIV Testing and Counselling (PITC) to all pregnant women in Zimbabwe [18] [42]. Since the majority of pregnant women are in the 20 -24 age group, this programme facilitates the enrolment of women into ART clinics at a younger age, and young mothers become beneficiaries of this facility [43].…”