Trends and correlates of HIV testing during pregnancy in racially/ethnically diverse insured population, 1997-2006

To describe the trends in human immunodeficiency virus (HIV) testing during pregnancy from 1997 through 2006, and the demographic, clinical, and health system correlates of being tested in a diverse insured population.

Health plan members who had one or more births at > or = 20 weeks gestation from January 1, 1997 through December 31, 2006 in Kaiser Permanente Southern California hospitals were included in this retrospective analysis. Data were obtained from the infants' birth certificate, and administrative and laboratory databases. Multiple log binomial regression analyses were used to generate adjusted prevalence ratios (PR) and 95% confidence interval (CI) for each characteristic.

Of the 240,575 women with 302,246 pregnancies, the proportion tested for HIV during pregnancy increased from 77.6% in 1997 to 91.0% in 2006 (P (trend) < 0.0001). Compared with Hispanic women, of which 90% were tested, non-Hispanic white women were least likely to be tested (81.7%: PR: 0.965; 95% CI: 0.957-0.973). Demographic characteristics negatively associated with HIV testing were maternal age >/=30, having more than a high school education, and residing in census blocks with the highest income tertile. Additionally, women were less likely to be tested after their first birth, if enrolling in prenatal care in the third trimester, or if they had a gap in insurance during their pregnancy. Of the 53,566 women with two sequential pregnancies, 78.5% were tested during both pregnancies.

In an insured racially/ethnically patient population, the testing rate exceeded 90% in 2006. Achieving and sustaining these high testing levels has public health implications.