Providing in-home HIV testing for pregnant women and their families: Challenges and benefits

Issues: Testing pregnant women for HIV is critical: infected women are more likely to accept medical treatment during pregnancy, and interventions can prevent transmission to infants. Prenatal care is especially important for pregnant women at risk for HIV infection, and home-based care models can increase access, improving infant and maternal outcomes.

Description: A partnership formed between a community-based organization providing maternal health services, an HIV medical clinic, and a faith-based community organization to incorporate HIV testing into an in-home prenatal and postpartum care program in an urban high-risk neighborhood. HIV counselors accompany maternal care advocates on home visits, offering HIV education, prevention counseling, and rapid testing to women, their partners and families. This innovative program's goals are to identify HIV-infected individuals and link them into care, and help at-risk women, their partners and families prevent HIV/STDs.

Lessons Learned: Within 6 months, 75 individuals received HIV education and prevention counseling, and 43 were tested (23% pregnant, 19% partners/family members; 0% seropositivity). Benefits: Privacy and convenience of home visits may increase likelihood of accepting HIV testing. Partners and family members who otherwise may not interface with health care system had increased access to HIV services. Challenges: integrating HIV services into maternal program within limited timeframe; ensuring safety, security, and client confidentiality in a home setting.

Recommendations: Develop partnerships between maternal care and HIV organizations to provide integrated home care. Develop plans to ensure safety and confidentiality when home HIV testing. Adapt traditional maternal care programs to involve partners and family members.