Active refusal increases human immunodeficiency virus screening in an urban prenatal clinic system

Abstract

Objective: To determine whether universal routine antenatal human immunodeficiency virus (HIV) testing with patient notification and active refusal (IOM, 1999) would increase HIV screening in our pregnant population. Methods: Since 1995, we have followed ACOG guidelines of universal pretest counseling and voluntary HIV screening of pregnant women. A prospective interventional study was begun August 1, 1999, and results are presented through February 29, 2000. The intervention group included all women receiving an initial antenatal visit in our eight maternity clinics. The primary intervention consisted of educating all maternity providers and requiring patients to actively refuse HIV testing. We also evaluated a more intensive intervention, consisting of the above plus chart reminders, periodic site visits by the investigators, and educational pamphlets at Central Health Clinic (CHC), a clinic with a historically low rate of screening. Controls included all women delivering in the year before the intervention. Results: The 2,105 cases and 4,088 historic controls were similar with respect to age, educational level, risk status, substance abuse, and history of sexually transmitted diseases. HIV testing increased from 74% in the preintervention group to 81% in the postintervention group ( P <0.0001). The more intensive intervention did not appear to be of additional benefit; HIV testing at CHC (intensive intervention) increased 45% (56% to 81%, P <0.0001) and, similarly, testing at Northern Health Clinic (primary intervention only, similar clinic size, low testing rate before intervention) increased 53% (53% to 81%, P Conclusion: A policy of active patient refusal is effective in increasing HIV screening among pregnant women in a large, urban obstetric clinic population.