200591 Opt-out HIV testing improves testing rates among pregnant women

Tuesday, November 10, 2009: 2:50 PM

Kristen E. Eron , Department of Infectious Diseases, Duke University Medical Center, Durham, NC
Sarah Kim , Department of Infectious Diseases, Duke University Medical Center, Durham, NC
Gregory Samsa, PhD , Department of Biostat and Bioinformatics, Duke University Medical Center, Durham, NC
Elizabeth G. Livingston, MD , Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
Charles B. Hicks, MD , Division of Infectious Diseases, Duke Unversity, Durham, NC
Background: Universal HIV testing in pregnancy is recommended and may help diminish stigma, but all pregnant women are not tested. Opt-out strategies may help.

Methods: Obstetrical delivery logs for 2007-08 were reviewed to determine HIV testing patterns at an academic medical center. Data for each year from the first 1000 consecutive deliveries in women age > 18 years were recorded including age, race, insurance status, timing/site of prenatal care, parity. RPR testing verified prenatal screening opportunity. Opt-out testing began 1 Nov 2007. Chi-square testing and logistic regression were used to analyze relationships.

Results: Only 1/2010 tested women was newly diagnosed HIV- infected. There were no significant differences between years for the following characteristics: age (mean 27.9 vs. 27.9 years); race (white: 30% vs. 28%, African American (AA): 30% vs. 33%, Hispanic: 32% vs. 32%); insurance (private: 42% vs. 39%, Medicaid/selfpay: 58% vs. 61%). Testing rates improved after opt-out testing was introduced: 841/1005 [84%] vs. 906/1005 [90%]; p=<0.0001. Testing was significantly more common among women with Medicaid, among those seen at public health (PH) facilities, among women born outside the US, and among non-white women; parity had no effect. Testing rates: Hispanic, AA, white patients (90%, 92%, 81%; p=<0.0001); Medicaid vs. private insurance (93%, 79%, p=<0.0001); PH vs. private (95%, 84%, p=<0.0001); US-born, Latin America, other (87%, 93%, 80%; p=<0.0001).

Conclusions: Opt-out HIV testing improves testing rates among pregnant women. Groups requiring additional focus include privately insured, US-born, white women. Systems facilitating routine testing during pregnancy may enhance testing rates.

Learning Objectives:
Evaluate the rates of HIV testing as part of prenatal care and compare the frequency of HIV testing in pregnant women in 2007 to the freqeuncy of this testing in 2008.

Keywords: HIV/AIDS, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I do not have any financial interests with any commercial entity. I also designed the study, collected the data, analyzed the data and wrote the abstract.
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.

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