177317 Prenatal HIV testing by undocumented immigrant women in Philadelphia's Public Health Centers

Sunday, October 26, 2008

Carol McLaughlin, MD MPH , Division of Infectious Disease, School of Medicine, University of Pennsylvania, Philadelphia, PA
Abike James, MD MPH , Obstetrics and Gynecology, University of Pennsylvania and the Philadelphia Department of Public Health, Division of Maternal, Child and Family Health, Philadelphia, PA
Scarlett Belamy Bellamy, ScD , Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA
Shiriki K. Kumanyika, PhD MPH , Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA
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.

Learning Objectives:
Assess the impact of immigration status on HIV testing by pregnant women receiving prenatal care in an urban US public health system. Identify patient and provider level factors associated with acceptance or decline of prenatal HIV testing. Design quality improvement initiatives, outreach and HIV educational programming to target risk groups that have high rates of testing refusal.

Keywords: Immigrant Women, Prenatal Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I completed the research and have the necessary prerequisite content specialization and epidemiology/public health training
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.