Stepping up from opt-out: Achieving 100% uptake antenatal human immunodeficiency virus testing

Area of Science:

• Public Health
• Infectious Disease Prevention
• Maternal-Fetal Medicine

Background:

• Routine screening for HIV, hepatitis B, and syphilis is offered to pregnant women in the UK.
• Excellent uptake minimizes mother-to-child HIV transmission, but some women decline testing.
• High HIV prevalence in the study area and the childbearing age of untested individuals highlight a need for improved engagement.

Purpose of the Study:

• To implement a quality improvement project for 100% HIV testing uptake among women delivering at the unit.
• To engage women declining antenatal HIV testing, including testing infants via cord blood.
• To address HIV testing barriers in a high-prevalence area.

Main Methods:

• A quality improvement project led by an HIV specialist midwife.
• Initial evaluation followed by modification of the approach.
• Utilized an innovative strategy with a trusted advocate for hard-to-reach populations.

Main Results:

• Achieved 100% uptake of HIV testing for all women delivering at the unit.
• Diagnosed two new cases of HIV in women who did not perceive themselves at risk.
• Both diagnosed women were engaged in care, and both delivered HIV-negative infants.

Conclusions:

• An inclusive, modified approach can achieve universal HIV testing in pregnant women, even in high-prevalence settings.
• Targeted strategies are effective in engaging hard-to-reach populations for HIV screening.
• Universal HIV testing ensures timely diagnosis and care, preventing mother-to-child transmission.