178322 Differences in HIV testing at delivery among women giving birth in public and private hospitals in Texas

Monday, October 27, 2008: 3:30 PM

M. Aaron Sayegh, PhD, MPH , Bureau of Epidemiology, Houston Department of Health and Human Services, Houston, TX
Sonia I. Arbona, PhD , HIV/STD Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX
Barry Mitchell, MPH , HIV/STD Program, Texas Department of State Health Services, Austin, TX
Marcia Becker, MPH , Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX
Sharon K. Melville, MD, MPH , HIV/STD Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX
Background: In Texas, opt-out HIV testing is mandated to be offered to pregnant women at the first prenatal visit and at delivery and reported on the birth certificate. . This study describes differences in prenatal and delivery HIV testing among women giving birth in Texas hospitals in 2001.

Methods: Data were obtained from birth certificate records and medical charts of a stratified random sample of 1499 women (and children) within 26 public and private hospitals in Texas. Analyses were conducted as a three-level hierarchical linear model to test differences in receipt of prenatal and delivery HIV testing. Hospital variables included funding type (Level 3) and service volume (Level 2). Level 1 covariates included race/ethnicity and prenatal HIV test. The outcome variable was having no test at delivery or missing test.

Results: The conditional probabilities of “no test” or “missing test” at delivery was higher for Caucasian women who had received a prenatal test (beta=0.29; p=0.00). High service volume was significantly associated with having received no or missing test at delivery .(beta=0.53; p=0.01). The probability of having received a prenatal HIV test decreased for public hospitals (beta = -0.42; p=0.00).

Conclusions: These data show that delivery HIV testing fluctuates with the service volume and prenatal testing fluctuates with funding source of the hospital, and that HIV testing at delivery is a function of race/ethnicity and prenatal HIV testing. Additionally, HIV testing requirements at delivery should be followed regardless of perceived risk associated with racial/ethnic membership or existence of a prior HIV test.

Learning Objectives:
Mandatory HIV pre natal and at delivery testing and public health reporting. Accuracy of birth certificate records for policy development. Individual and system risk factors associated with testing and reporting discordance. Analyzing nested data.

Keywords: HIV/AIDS, Hospitals

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the principal investigator for the project that collected these data and am a content expert in the HIV testing for public health use.
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.