Determinants of antepartum hiv testing in a non-medicaid obstetric population

OBJECTIVE: To assess: (1) rates of voluntary HIV testing and (2) demographic or risk factors associated with consent to HFV testing in an urban private-practice obstetric setting. STUDY DESIGN: All patients registering for prenatal care from January 1996 onward completed a yes-no questionnaire designed as a self-assessment tool for spécifie HIV risk factors. HfV testing was then offered separately to all patients. Demographic and risk data were analyzed for the group as a whole and in relation to HIV testing rates. RESULTS: Of the 404 women completing the questionnaire, 243 (60%) consented to HIV testing. In a univariate analysis, patients with any perceived risk for HIV infection (27% of all) were more likely to be tested than those without self-assigned risks (73% vs 54%; p = 0.001), as were women perceiving their partners to be at risk [(PR), 4.4% of all, 77% vs 55%; p = 0.03], and those women (19% of all) with sexually transmitted disease (STD) histories (79% vs 54%; p < 0.001). Single or divorced women (26% of all) were also more likely to be tested than those who were married (69% vs 56%; p = 0.03). In a multivariate regression model including age along with these factors, only STD history (p = 0.009) and PR (p = 0.04) were significantly associated with HIV testing. No women in the cohort had a positive HIV test result. CONCLUSIONS: With the availability of anteparturn treatment to decrease the risk of vertical HIV transmission, some authorities have called for universal anteparturn HIV testing. We have demonstrated that, in a private-practice obstetric setting in which 27% of women perceive themselves at risk for HIV infection, voluntary testing rates vary from 50-80% depending on specific self-assessed risks. A woman's history of STDs or an at-risk sexual partner were much stronger predictors of voluntary HIV testing than either marital status or age. Still, 20% of women at highest risk for infection declined HIV testing. These results may help focus HIV counselling efforts among pregnant women at relatively low risk for infection.