Potential factors that may affect acceptance of routine prenatal HIV testing

Despite increasing advocacy for an "opt-out" strategy in routine prenatal HIV screening programs in Canada, no published studies have examined factors that may affect acceptance of prenatal HIV testing.

We included all pregnant women in Alberta who received prenatal care (N = 38,712) and their caregivers (N = 2,007) between January 1 and November 30, 2000. Factors associated with non-acceptance of HIV testing in both pregnant women and their caregivers were assessed using multivariate logistic regression.

Overall, 1.5% of women declined HIV testing. First Nations women were about twice as likely to decline the test (adjusted odds ratio [OR(adj)] 1.91, 95% CI [1.42-2.58]) compared to non-First Nations women (p < 0.001). The proportion also increased with age (chi2 trend p < 0.001) in the general population. In First Nations women, however, most (3.2%) declined in the 20-24 year age group. No significant effect was seen for a socio-economic status marker or for the place of residence. The caregivers of women who declined HIV testing were more likely to be female (OR(adj) 1.56 [1.28-1.89]), midwives (OR(adj) 140.65 [58.61-337.49]), other non-obstetrical medical specialties (OR(adj) 4.92 [1.94-12.47]), and general practitioners (OR(adj) 3.44 [1.87-6.33]).

In an "opt-out" routine prenatal HIV screening program, the characteristics of both the pregnant women and their caregivers may contribute to the non-acceptance of HIV testing. A higher likelihood of declining HIV testing among First Nations pregnant women and other pregnant women under the care of midwives and female physicians warrants further study.