Pregnant Women and HIV

Opt-out approach to HIV testing during pregnancy

Relevance for Title IV Providers: The Institute of Medicine and the CDC have recommended an opt-out approach to HIV testing during pregnancy to assure that all pregnant women receive appropriate HIV screening. This study reported on one urban public health hospital's experience with using the verbal opt-out method. At this medical center, HIV screening was recommended during pregnancy and women were given an opportunity to refuse testing; those who gave verbal permission had an HIV test obtained at the same time that other standard prenatal laboratory tests were done.

Study Question(s): Does use of the verbal opt-out approach promote HIV screening during pregnancy?

Study Participants: Women giving birth at DHMC from 1998-2001. The study population age range was 13-46 years (average age was 24), and most (82%) were of Hispanic ethnicity.

Study Methods: HIV testing rates were determined based on billing for HIV testing. The accuracy of this approach was confirmed by reviewing a randomly selected pool of medical charts.

Study Findings: HIV testing was completed in 98.2% of pregnancies resulting in delivery at DHMC (12,000 out of 12,221). The average time in prenatal care differed significantly between women who had been tested for HIV versus (5 months) and women who were not tested (1 day). Of the 221 women who were not screened for HIV during pregnancy, only 24 actively refused HIV testing.

Limitations: The study information did not allow researchers to clearly define the reasons HIV screenings were not performed. It is also possible that providers did not document a refusal in the medical record, and therefore the chart review may have underestimated the rate of refusal of HIV screening.

Lessons Learned: A verbal opt-out system was very effective in promoting HIV screening during pregnancy (98.2% adherence rate). The study results suggest that the opt-out testing strategy can be effective in promoting HIV screening during pregnancy in a large urban hospital that provides care for a diverse patient population.

Implications for Title IV Providers: This study found that the most common reason that HIV screening had not been done was because of a lack of prenatal care and presentation during labor. This demonstrates the importance of examining strategies to get women into prenatal care, and using strategies like rapid HIV testing in labor to help reduce the risk of transmitting HIV to their infants.

Source: Breese P, Burman W, Shlay J, Guinn D. The effectiveness of a verbal opt-out system for human immunodeficiency virus screening during pregnancy. Obstetrics and Gynecology. 2004 Jul;104(1):134-7.