Opt-out HIV testing improves testing rates among pregnant women

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.