Prenatal HIV testing by undocumented immigrant women in Philadelphia's Public Health Centers

Objectives: Pregnant women receiving prenatal care through Philadelphia's Public Health Centers are increasingly diverse: 50% are foreign-born and more than a quarter are undocumented. Although essential to prevention of mother-to-child transmission, there is scant data on prenatal HIV testing patterns by this population. Study objective were: (1) determine rates of offer and acceptance of HIV testing, (2) compare rates for Medicaid eligible and ineligible (undocumented) women, (3) identify factors associated with absence of testing.

Methods: Using the registration database, a stratified random sample of women (286 Medicaid-eligible, 288 ineligible) was selected from the population initiating prenatal care in FY2005. Data were abstracted from prenatal charts and analyzed using weighted techniques for disproportionate sampling to estimate population testing rates.

Results: Overall, 96% of pregnant women were offered HIV testing; 83% accepted and received testing. There were no statistically significant differences between Medicaid eligible and ineligible (undocumented) women in rates of test offer, acceptance, or receipt. Women were more likely to decline testing if they were non-Hispanic, white, non-English or non-Spanish speaking, foreign-born, or had a history of a previous pregnancy or HIV test. The primary reasons women declined testing included their perception of not being at risk and a previous negative result.

Conclusion: Undocumented immigrant women have similar rates of being offered and accepting prenatal HIV testing compared to other pregnant women in an urban public health system. To increase acceptance rates, programming should make HIV testing routine (opt-out approach), encourage testing with each pregnancy, and increase outreach in additional languages.