Sustaining HIV testing in pregnancy- evaluation of routine offer of HIV testing in three London hospitals over 2 years

This study sets out to examine how routine offers of HIV testing for pregnant women in ante-natal (prenatal) clinics are managed over time. Data was collected over two time periods (2002, 2004) from all women booking clinics at three London hospitals. Data from 3,560 women, comprising 2,710 in 2002 (time 1) and 850 in 2004 (time 2) were gathered. Uptake of HIV testing, demographic variables, HIV-associated risks, pregnancy variables and uptake of other ante-natal tests were monitored. In the later study, details of partner testing and time spent discussing HIV was monitored. HIV test uptake with routine offer (RCT) was high. There was a significant increase in HIV testing over time from 85 to 91% (p<0.0001). In 2004, significantly more women had been previously tested for HIV (25 versus 41%, p<0.0001), more women refused all other ante-natal tests (rubella [0 versus 4% p<0.0001], syphilis [1 versus 5%, p<0.0001], Haemoglobin [1 versus 3%, p<0.0001], Down's syndrome [0 versus 13%, p<0.0001] and hepatitis B [1 versus 5%, p<0.0001]). Significantly less women refused HIV test (15 versus 9%, p<0.0001). Initially, HIV was the most frequently refused test (15%), whereas at time 2 Down's syndrome tests were most frequently declined. At time 1, 2% declined any test. By time 2, 14% of the sample declined any test (p<0.0001). Three percent of women had an established HIV risk at time 1 and 6% at time 2. Women with risk factors were significantly less likely to accept testing at time 2, but not at time 1 or not overall. Multivariable analysis was carried out to look at predictors of opting in and opting out of testing. At time 2 HIV test uptake was more likely if less than 3 min was spent discussing it (chi2=9.3, p=0.002). This information was not available at time 1. HIV testing in ante-natal care can be sustained over time. Challenges for the future relate to complex cases, test declining, ensuring that women with risk factors do not systematically decline and providing skills for midwives or referral pathways to deal with more demanding cases. It has been possible to normalise HIV testing. Women have responded with high HIV test uptake, but are also questioning other tests which were previously routinely offered.