Factors affecting uptake of antenatal HIV testing in London: results of a multicentre study.

Introduction

Antiretroviral therapy[1] and avoidance of breastfeeding' can reduce the risk of mother to child transmission of HIV from 25-30% to 5-8%.[3 4] In the United Kingdom, women who know their HIV status are increasingly taking up these interventions.[5] Despite national guidelines recommending that antenatal HIV testing should be offered to all women in areas of higher prevalence such as London,[6] in 1995 only 13 (39%) of the 33 London maternity units had a policy of offering testing to all pregnant women.[7] Nationally, detection of previously undiagnosed HIV infection in pregnancy has remained below 10%.[8] Ibis study reports the offer and uptake of antenatal HIV testing in six London maternity units and examines how these are related to maternal risk of exposure to HIV and screening practices.

Methods

Six inner London maternity units with high HIV seroprevalence participated in the study. All had a "universal offer" policy, but implementation varied between units (see table 1). Within each unit, data on demographic and obstetric factors, including risk factors for HIV infection, were collected by questionnaire over a 12 month period during 1995 and 1996. Data on the number of women booking for antenatal care from each unit were collected and checked with laboratory data on number of samples sent for rubella antibody testing.

Data were analysed with univariate and multivariate logistic regression models controlling for hospital, risk category, ethnic group, place of booking interview, age, whether HIV was discussed and testing offered, and the interaction between hospital and risk category. Risk category included data on risks disclosed during the antenatal interview, and the categories "black African" and "partner black African," derived from self report of ethnic group and country of birth. The category "exposed in Africa" included any women born in Africa and those who gave their ethnic group as black African.

Results

One unit was excluded from the analysis (unit F) because only 17% of …