Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #108174

Naomi Rutenberg, PhD¹, Carolyn Baek, MSC¹, Susan Kaai, MSc², and Scott Geibel, MPH². (1) Horizons, Population Council, 4301 Connecticut Ave, NW Suite 280, Washington, DC 20008, (202)237-9405, nrutenberg@pcdc.org, (2) Horizons, Population Council, P.O. Box 17643, Nairobi, Kenya

A major policy shift to prevent mother-to-child transmission (PMTCT) of HIV is from counseling pregnant women about the HIV test and asking them to test (“opt-in”) to informing women that testing is part of routine antenatal care unless women “opt out.” This latter approach may offer benefits such as reduced counseling demands and increased coverage, but may be offset by decreased HIV education. We compare these two approaches in Kenya. Data before the policy shift comes from 397 and 652 women interviewed in 2001-2 in Homa Bay and Karatina District Hospitals. Data after the policy change is from interviews of 1803 women in a low income area of Nairobi in 2004. Respondents had given birth in the previous 10 weeks. The demographic profile of clients, intensity and time in which PMTCT programs had been in place in the study sites are broadly similar. Both approaches achieved similar testing coverage: 86% and 68% of women at the opt-in sites compared with 81% under the opt-out system. More women received their results with opt-out (93%) than opt-in (89% and 82%) and disclosed their results to their sexual partner (84% versus 64% and 58%). Knowledge of strategies to avoid MTCT was lower in the sites with opt-out testing. Opt-out approaches should consider strategies for intensifying HIV education to ensure that women get the full benefits of a PMTCT program.

Learning Objectives:

• Define opt-in and opt-out concepts of HIV testing during antenatal care.
• Describe the reasons for a policy shift to an opt-out approach.
• Identify strengths and weaknesses of the opt-out approach based on an evaluation in Kenya.

Keywords: Women and HIV/AIDS, Children's Health

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.