Factors affecting uptake of antenatal HIV testing in London: results of a multicentre study

BMJ 1998;316:259-261 (24 January)

Papers

Factors affecting uptake of antenatal HIV testing in London: results of a multicentre study

Diana M Gibb, senior lecturer in epidemiology,^a Sandra E MacDonagh, research midwife,^a Ramyani Gupta, research fellow,^a Pat A Tookey, research fellow,^a Catherine S Peckham, professor in epidemiology and public health,^a A E Ades, reader in epidemiology and public health ^a

^a Department of Epidemiology and Public Health, Institute of Child Health, London WCIN 1EH

Correspondence to: Dr Gibb d.gibb@ich.ucl.ac.uk

Objectives: To measure the uptake of antenatal HIV testing anddetermine its relation to risk of HIV and to screening practices.
Design: Multicentre prospective questionnaire study.
Subjects: Pregnant women attending six maternity units.
Setting: Inner London, 1995-6.
Main outcome measures: Uptake of testing by risk factors forHIV, ethnicity, and factors about the antenatal interview.
Results: All units had a "universal offer" policy for HIV testing.In five units forms were completed for 18 791 (88%) of 21 247pregnant women. The sixth unit, where the response rate wastoo low to assess uptake, was excluded from the analysis. Uptakeranged from 3.4% to 51.2% (overall 22.9%), in parallel withdetection of previously undiagnosed infection in pregnant women(4.9-60%). Controlling for unit, uptake was higher among the7% who disclosed risk factors. Among those at low risk, uptakevaried by ethnic group (South Asian women 9%; Latin Americanand Mediterranean women 33%). The relation between uptake andHIV risk category varied greatly across units. Despite increasedHIV seroprevalence in black African women, uptake was similarin this group to that among women at low risk (24%). Uptakeincreased 2.1-fold if HIV transmission was discussed. Midwivesreported spending 7 (2-15) minutes discussing HIV issues.
Conclusions: Uptake of HIV testing was unacceptably low in allunits, with maternity unit the strongest predictor. New approachesto antenatal HIV testing are urgently required and uptake shouldbe audited routinely.

Key messages

In five major maternity units in inner London, all with "universal offer" policies, fewer than 1 in 4 women were tested for HIV during pregnancy in 1995-6
Maternity unit was the most important factor determining uptake of HIV testing, which ranged from 3% to 51%, in parallel with detection of previously undiagnosed infection during pregnancy
Maternity units with the lowest uptake of antenatal HIV testing had the largest differences in uptake between groups of women with different risk factors for HIV
Uptake of testing among women exposed in Africa was no higher than among women with no disclosed risk, despite much higher HIV seroprevalence in the former group
New approaches to antenatal HIV testing are urgently required; ongoing routine audit of the uptake of antenatal HIV testing is essential if higher uptake rates are to be achieved and maintained

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to Technorati Technorati What's this?

Reducing the vertical transmission of HIV: Babatunde A Gbolade, K H Tan, K P Teo, Ben Essex, Mary A Waldron, Elizabeth Foley, V Harindra, Meg Goodman, Adeola Olaitan, Sara Madge, Melvyn Jones, Margaret Johnson, Fabio Parazzini, Elena Ricci, Paola Grasso, Matteo Surace, Guido Benzi, and Paquita de Zulueta
BMJ 1998 316: 1899. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Deblonde, J., Claeys, P., Temmerman, M. (2007). Antenatal HIV screening in Europe: a review of policies. Eur J Public Health 17: 414-418 [Abstract] [Full text]
Stokes, S. H M, McMaster, P., Ismail, K. M K (2007). Acceptability of perinatal rapid point-of-care HIV testing in an area of low HIV prevalence in the UK. Arch. Dis. Child. 92: 505-508 [Abstract] [Full text]
Sharland, M, Gibb, D M, Tudor-Williams, G (2003). Advances in the prevention and treatment of paediatric HIV infection in the United Kingdom. Sex. Transm. Infect. 79: 53-55 [Full text]
Sharland, M, Gibb, D M, Tudor-Williams, G (2002). Advances in the prevention and treatment of paediatric HIV infection in the United Kingdom. Arch. Dis. Child. 87: 178-180 [Full text]
Keane, F E A, Neale, J, Phillips, T, Heard, L, Jones, R, Guttridge, B, Bendall, R (2002). Offering routine antenatal testing for HIV and hepatitis B in the rural setting of Cornwall. Sex. Transm. Infect. 78: 133-134 [Abstract] [Full text]
Erwin, J, Morgan, M, Britten, N, Gray, K, Peters, B (2002). Pathways to HIV testing and care by black African and white patients in London. Sex. Transm. Infect. 78: 37-39 [Abstract] [Full text]
Gilbert, R E, Augood, C, Gupta, R, Ades, A E, Logan, S, Sculpher, M, van der Meulen, J H P, Wallace, E. M, Mulvey, S. (2001). Screening for Down's syndrome: effects, safety, and cost effectiveness of first and second trimester strategies Commentary: Results may not be widely applicable Authors' response. BMJ 323: 423-423 [Abstract] [Full text]
de Zulueta, P. (2000). The ethics of anonymised HIV testing of pregnant women: a reappraisal. J. Med. Ethics 26: 16-21 [Abstract] [Full text]
Nicoll, A., Peckham, C. (1999). Reducing vertical transmission of HIV in the UK. BMJ 319: 1211-1212 [Full text]
(1999). HIV in pregnancy and early childhood. DTB 37: 65-67 [Abstract] [Full text]
Gbolade, B. A, Tan, K H, Teo, K P, Essex, B., Waldron, M. A, Foley, E., Harindra, V, Goodman, M., Olaitan, A., Madge, S., Jones, M., Johnson, M., Parazzini, F., Ricci, E., Grasso, P., Surace, M., Benzi, G., de Zulueta, P. (1998). Reducing the vertical transmission of HIV. BMJ 316: 1899-1899 [Full text]
Mercey, D. (1998). Antenatal HIV testing. BMJ 316: 241-242 [Full text]