Abstract
In 1999, Ontario implemented a policy to offer HIV counseling and testing to all pregnant women and undertook measures to increase HIV testing. We evaluated the effectiveness of the new policy by examining HIV test uptake, the number of HIV-infected women identified and, in 2002, the HIV rate in women not tested during prenatal care. We analyzed test uptake among women receiving prenatal care from 1999 to 2010. We examined HIV test uptake and HIV rate by year, age and health region. In an anonymous, unlinked study, we determined the HIV rate in pregnant women not tested. Prenatal HIV test uptake in Ontario increased dramatically, from 33% in the first quarter of 1999 to 96% in 2010. Test uptake was highest in younger women but increased in all age groups. All health regions improved and experienced similar test uptake in recent years. The HIV rate among pregnant women tested in 2010 was 0.13/1,000; in Toronto, the rate was 0.28 per 1,000. In the 2002 unlinked study, the HIV rate was 0.62/1,000 among women not tested in pregnancy compared to 0.31/1,000 among tested women. HIV incidence among women who tested more than once was 0.05/1,000 person-years. In response to the new policy in Ontario, prenatal HIV testing uptake improved dramatically among women in all age groups and health regions. A reminder to physicians who had not ordered a prenatal HIV test appeared to be very effective. In 2002, the HIV rate in women who were not tested was twice that of tested women: though 77% of pregnant women had been tested, only 63% of HIV-infected women were tested. HIV testing uptake was estimated at 98% in 2010.
Highlights
In 1989–91, Coates observed an HIV prevalence of 0.28 per 1,000 in pregnant women in Ontario [1]
Study 1: Prenatal HIV test uptake HIV test uptake increased from 40% in 1999 to 96% in 2010
The increase in test uptake was similar across age groups and health regions, though regions with lower uptake initially tended to increase more so that inter-regional variations were less in later years
Summary
In 1989–91, Coates observed an HIV prevalence of 0.28 per 1,000 in pregnant women in Ontario [1]. In 1994, O’Connor reported that zidovudine prophylaxis reduced mother-infant HIV transmission by 67% [2]. The Ontario Ministry of Health advised physicians to offer HIV testing to pregnant women at increased risk but test uptake remained low. In 1997, we estimated that HIV prevalence among pregnant women was substantially higher than that reported by Coates. The Ontario Ministry of Health recommended that, beginning in January 1999, HIV counseling and testing should be offered to all pregnant women. The policy recommended an ‘‘opt-in’’ approach i.e. HIV testing carried out with pre-test counseling and informed consent
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