Estimating prenatal syphilis and HIV screening rates for commercially insured women

Although routine serologic testing for syphilis and human immunodeficiency virus (HIV) for all pregnant women is recommended by the Centers for Disease Control and Prevention and many health professional organizations, little is known about the extent of prenatal syphilis and HIV screening rates among commercially insured pregnant women.

A claims database for a large commercially insured population was analyzed to estimate syphilis and HIV screening rates for pregnant women who were continuously enrolled in the same health insurance plan during 1998 and 1999 in 13 U.S. states. Diagnostic and procedural services were used to determine pregnancy status, receipt of prenatal care, and syphilis and HIV testing during pregnancy.

Of 13,250 identified pregnancies, 12,156 (92%) were among women who had prenatal visits; 8368 (63%) included claims for syphilis testing; and 4411 (33%) included claims for HIV testing. Of the 8368 pregnancies with syphilis testing, 6326 (76%) included syphilis tests that were performed during the initial prenatal visit. Of the 4411 pregnancies with HIV testing, 3168 (72%) included HIV testing on the initial prenatal visit. Of 4249 pregnancies with syphilis and HIV testing, 3146 (74%) included HIV testing and syphilis testing on the initial prenatal visit.

Most HIV and syphilis tests had been provided during initial prenatal visits among women who had HIV and syphilis testing. Prenatal screening rates for syphilis and HIV identified through claims were lower than expected. This may be due to deficiencies in documentation of syphilis and HIV screening in administrative databases or actual screening rates. Further investigation is needed to determine how accurately claims data can measure actual screening practices.