AEGiS-14IAC: Assessment of universal HIV voluntary counseling, test offering and testing for prenatal women in California.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Assessment of universal HIV voluntary counseling, test offering and testing for prenatal women in California.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. ThOrD1399)

Montgomery ET, Kropp R, Hill DW, Ruiz J, Maldonado YA
Stanford University, Department of Pediatrics, Stanford, CA, United States

BACKGROUND: In response to US Public Health Service recommendations to reduce maternal-child transmission of HIV, California enacted a State law in 1996 mandating: 1) the universal offering of an HIV test to all women in prenatal care (PNC), 2) documentation of this offer in the medical record; and 3) a discussion of the risks and benefits and the voluntary nature of the test ("counseling"). However, it is unknown how thoroughly this law has been implemented in practice, and there is currently no mechanism in place to monitor compliance with this law.

METHODS: 1) Semi-structured survey with 1362 pregnant/ recently delivered women (<6 months); 2) Anonymous survey of PNC providers; 3) Seven focus group discussions.

RESULTS: Less than half of women (47.3%) report receiving counseling, and only 74.3% report being offered an HIV test. Once offered a test, the majority (90.0%) accept. 135 surveyed providers (81.5% were MDs) report that more than 90% of patients are counseled in 96.1% of practices, and offered testing in 91.9%. Focus group respondents describe widely differing VCT experiences, perceptions of whether counseling and test-offering occurred were subject to interpretation, and knowledge of legal rights to receive and voluntarily accept the test were poorly understood.

CONCLUSIONS: Rates of HIV counseling and test offering, are far shy of universal, and opportunities for intervention may be lost. An evaluation of compliance to the mandate is subject to interpretation, estimation, and recall bias. The results lend support to a revised policy of routine HIV testing where women have right of refusal. At a minimum, state or national health agencies should provide monitoring to encourage provider accountability and compliance with the law. Clients should be educated about their rights to receive and make an informed choice about VCT.

Keywords: AEGIS, Counseling, HIV Infections, Prenatal Care, Research Design, HIV, Anti-HIV Agents, Dental Materials, Collodion, California, HIV Seropositivity, Patient Compliance, Mass Screening, Universal, Human, Female, Child, Pregnancy

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ThOrD1399