Women's Opinions about Routine HIV Testing During Pregnancy: Implications for the Opt-Out Approach

Abstract

The 1995 United States Public Health Service (USPHS) recommendation regarding HIV testing for pregnant women was revised in 2003 calling for routine HIV testing for pregnant women with patient notification. Routine testing (opt-out screening) offers women the opportunity to decline HIV testing but eliminates the requirement of pretest counseling and separate written consent. To assess women's opinions about the opt-out approach to HIV testing during pregnancy, a cross-sectional survey was conducted in May-June 2004 at 14 geographically diverse clinics funded by Ryan White CARE Act (RWCA) Part C and Part D agreements. Of 853 women respondents to the one-page, self-completed survey questionnaire, 90% agreed with routine HIV testing and 91% reported being comfortable with testing, demonstrating that the large majority of women agree with and support HIV testing as a part of routine prenatal care. Women's opinions were associated with HIV testing status, e.g., 76% of women who had never been tested for HIV thought HIV testing should be part of a routine pregnancy check-up as compared with women who were HIV-negative (93%) or HIV-positive (90%) (chi(2) = 31.3943, p < 0.0001). Comfort with HIV testing was associated with higher HIV knowledge. Approximately half of the respondents indicated that HIV tests are different from other tests and that women need more information prior to testing. Results demonstrated clear consensus in support of routine testing. Increased efforts to disseminate resources to providers coupled with providers' effective communication of information to pregnant women can build on the support that women have conveyed for HIV testing during pregnancy.

Associations between Mode of HIV Testing and Consent, Confidentiality, and Referral: A Comparative Analysis in Four African Countries

“…The standards defined by guidelines on testing, such as informing clients, obtaining consent, and providing information, are not especially exacting, and can be achieved in most settings. Other studies, such as in the United States [33],[34] and in Egypt [35], have reported similarly high levels of service provision ad satisfaction.…”

Real-world performance of the new US HIV testing algorithm in medical settings

“…There are unique opportunities to test patients who visit the emergency department or urgent care but might not otherwise seek testing [4-7], and hospital-wide routine HIV screening has been shown to be a valuable tool for identifying new infections and preventing missed opportunities to diagnose individuals of unknown status [8,9]. These testing opportunities can be driven by symptoms, which may indicate acute HIV infection [10] or by the patient care situation (e.g., pregnancy) [11,12]. In caring for patients who are sick, ready for discharge, or in labor, there can be a premium on rapid turnaround time.…”

Implementation of Routine HIV Testing in an Acute Care Hospital in Rhode Island: A Nurse-Initiated Opt-Out Pilot Project

“…Expansion of routine HIV screening in prenatal care settings (Podhurst, Storm, & Dolgonos, 2009), primary care clinics (Cook & Berkenblit, 2009), urgent care centers , emergency departments (Merchant et al, 2009), community health centers (Cunningham et al, 2009), outpatient clinics (Anaya et al, 2008), and corrections facilities (Beckwith et al, 2011;Kavasery et al, 2009aKavasery et al, , 2009b has been documented. Further expansion is needed to improve the potential benefits of early detection.…”