INTRODUCTION: Mother-to-child transmission is the most important source of HIV infection in children. Low uptake of prevention of mother-to-child transmission of HIV (PMTCT) interventions requires new approaches to prevent missed opportunities. Routine HIV testing (“opt-out”) in antenatal care (ANC) has been reported to improve results of PMTCT interventions. The objective was to determine the acceptability of the opt-out strategy for HIV screening during pregnancy in Zimbabwe, a high HIV prevalence country.

METHODS: A descriptive cross sectional survey was conducted in six PMTCT sites. A set of four questionnaires was applied to interview 520 women over a three-month period. Women were identified at either postnatal services or in the OI clinic.

RESULTS: Of 520 women sampled, 285 women (55%) had been HIV tested during pregnancy. Unemployment of partner (p=<0.001), primary education or lower (p= 0.02), not receiving group education (p<0.001) or pre-test counselling (p<0.001) and having attended less then six ANC visits (p=<0.001) were associated with not having been HIV tested. Women with knowledge of PMTCT were more likely to be HIV-tested (p<0.001). Amongst the 235 women not HIV-tested in ANC, 80% would accept HIV-testing if routine testing was introduced in ANC services. Factors associated with accepting the opt-out approach were, being married (p=0.03), secondary education or more (p=0.03) and having received group education (p=<0.001). 41 women would still opt-out and refuse HIV-testing mainly because they fear knowing their HIV status and need to have partner consent.

CONCLUSION: Introduction of routine HIV testing in antenatal care is acceptable to most women and would increase uptake of PMTCT services. In Zimbabwe, where 25% of pregnant women are HIV infected, introduction of these strategies would have a far reaching public health impact. Issues regarding, stigma, quality of post-testing counselling and staffing will need to be considered.