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Canadian Journal of Public Health = Revue Canadienne de Santé Publique logoLink to Canadian Journal of Public Health = Revue Canadienne de Santé Publique
. 2005 Jan 1;96(1):60–64. doi: 10.1007/BF03404020

Potential Factors That May Affect Acceptance of Routine Prenatal HIV Testing

Fu-Lin Wang 116,✉, Bryce Larke 116, Stephan Gabos 116, Donald Schopflocher 116, Anita Hanrahan 216
PMCID: PMC6976195  PMID: 15682699

Abstract

Background

Despite increasing advocacy for an “opt-out” strategy in routine prenatal HIV screening programs in Canada, no published studies have examined factors that may affect acceptance of prenatal HIV testing.

Methods

We included all pregnant women in Alberta who received prenatal care (N=38,712) and their caregivers (N=2,007) between January 1 and November 30, 2000. Factors associated with non-acceptance of HIV testing in both pregnant women and their caregivers were assessed using multivariate logistic regression.

Results

Overall, 1.5% of women declined HIV testing. First Nations women were about twice as likely to decline the test (adjusted odds ratio [ORadj] 1.91, 95% CI [1.42–2.58]) compared to non-First Nations women (p<0.001). The proportion also increased with age (χ2trend p<0.001) in the general population. In First Nations women, however, most (3.2%) declined in the 20–24 year age group. No significant effect was seen for a socio-economic status marker or for the place of residence. The caregivers of women who declined HIV testing were more likely to be female (ORadj 1.56 [1.28–1.89]), midwives (ORadj 140.65 [58.61–337.49]), other non-obstetrical medical specialties (ORadj 4.92 [1.94–12.47]), and general practitioners (ORadj 3.44 [1.87–6.33]).

Conclusion

In an “opt-out” routine prenatal HIV screening program, the characteristics of both the pregnant women and their caregivers may contribute to the non-acceptance of HIV testing. A higher likelihood of declining HIV testing among First Nations pregnant women and other pregnant women under the care of midwives and female physicians warrants further study.

MeSH terms: HIV, prenatal, screening, prevention and control, policy

References

  • 1.Walmsley S. Opt in or opt out: What is optimal for pre-natal screening for HIV infection? CMAJ. 2003;168:707–8. [PMC free article] [PubMed] [Google Scholar]
  • 2.Jayaraman GC, Preiksaitis JK, Larke B. Mandatory reporting of HIV infection and opt-out prenatal screening for HIV infection: Effect on testing rates. CMAJ. 2003;168:679–82. [PMC free article] [PubMed] [Google Scholar]
  • 3.Mossman CL, Ratnam S. Opt-out prenatal HIV testing in Newfoundland and Labrador. CMAJ. 2002;167:630–31. [PMC free article] [PubMed] [Google Scholar]
  • 4.O’Connor KS, MacDonald SE. Aiming for zero: Preventing mother-to-child transmission of HIV. CMAJ. 2002;166:909–10. [PMC free article] [PubMed] [Google Scholar]
  • 5.Canadian Medical Association. Resolution Passed at the 135th Annual Meeting, Aug. 18–21, 2002; Saint John, New Brunswick. Ottawa: Canadian Medical Association; 2002. [Google Scholar]
  • 6.Government of Alberta News Release. Routine prenatal HIV screening program launched. Edmonton: Alberta Health and Wellness; 1998. [Google Scholar]
  • 7.Alberta Routine Prenatal HIV Screening Program: Final evaluation report prepared for Alberta Medical AssociationAlberta HealthWellness. Edmonton: Howard Research and Instrumental Systems. 2001. [Google Scholar]
  • 8.Alberta HealthWellness. Alberta Blood-Borne Pathogens Surveillance Report 2003. Edmonton, Alberta: Alberta Health and Wellness; 2003. [Google Scholar]
  • 9.Institute of Medicine, Committee on Perinatal Transmission of HIVCommission on BehavioralSocial SciencesEducation. Reducing the Odds: Preventing Perinatal Transmission of HIV in the United States. Washington: National Academy Press; 1999. [Google Scholar]
  • 10.Centers for Disease ControlPrevention. HIV testing among pregnant women — United States and Canada, 1998–2001. MMWR. 2002;51(45):1013–16. [PubMed] [Google Scholar]
  • 11.Simpson WM, Johnstone FD, Goldberg DJ, Gormley SM, Hart GJ. Antenatal HIV testing: Assessment of a routine voluntary approach. BMJ. 1999;318:1660–61. doi: 10.1136/bmj.318.7199.1660. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Simpson WM, Johnstone FD, Boyd FM, Goldberg DJ, Hart GJ, Prescott RJ. Uptake and acceptability of antenatal HIV testing: Randomized controlled trial of different methods of offering the test. BMJ. 1998;316:262–67. doi: 10.1136/bmj.316.7127.262. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Ethier KA, Fox-Tierney R, Nicholas WC, Salisbury KM, Ickovics JR. Organizational predictors of prenatal HIV counseling and testing. Am J Public Health. 2000;90:1448–51. doi: 10.2105/AJPH.90.9.1448. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Lansky A, Jones JL, Frey RL, Lindegren ML. Trends in HIV testing among pregnant women: United States, 1994–1999. Am J Public Health. 2001;91:1291–93. doi: 10.2105/AJPH.91.8.1291. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Lindsay MK, Adefris W, Peterson HB, Williams H, Johnson J, Klein L. Determinants of acceptance of routine voluntary human immunodeficiency virus testing in an inner-city prenatal population. Obstet Gynecol. 1991;78:678–80. [PubMed] [Google Scholar]
  • 16.Ogilvie G, Adsett S, Macdonald G. Do physicians discuss HIV testing during prenatal care? Can Fam Phys. 1997;43:1376–81. [PMC free article] [PubMed] [Google Scholar]
  • 17.MacDonald SE, Hartling LA, Sequin RM, O’Connor KS, Rekart ML, Mowat DL, et al. Screening for HIV during pregnancy. Survey of physicians’ practices. Can Fam Phys. 2001;47:2250–57. [PMC free article] [PubMed] [Google Scholar]
  • 18.O’Connor KS, MacDonald SE, Hartling L, Seguin RM, Hollands H, Mowat DL, et al. The influence of prevalence and policy on the likelihood that a physician will offer HIV screening in pregnancy. Can J Public Health. 2002;93(1):31–35. doi: 10.1007/BF03404414. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Guenter D, Carroll J, Kaczorowski J, Sellors J. Prenatal HIV testing in Ontario: Knowledge, attitudes and practices of prenatal care providers in a province with low testing rates. Can J Public Health. 2003;94(2):93–97. doi: 10.1007/BF03404579. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Okun NB, Larke B, Waters JR, Joffres MR. Success of a program of routine prenatal screening for hepatitis B surface antigen: The first 2 years. CMAJ. 1990;143(12):1317–21. [PMC free article] [PubMed] [Google Scholar]
  • 21.Roos LL, Walld R, Wajda A, Bond R, Hartford K. Record linkage strategies, outpatient procedures, and administrative data. Med Care. 1996;34(6):570–82. doi: 10.1097/00005650-199606000-00007. [DOI] [PubMed] [Google Scholar]
  • 22.Schafer JL, Graham JW. Missing data: Our view of the state of the art. Psychol Methods. 2002;7(2):147–77. doi: 10.1037/1082-989X.7.2.147. [DOI] [PubMed] [Google Scholar]
  • 23.Messiah A, Rey D, Obadia Y, Rotily M, Moatti JP. HIV testing, knowledge, attitudes, beliefs, and practices among minorities: Pregnant women of North-African origin in southeastern France. J Nat Med Assoc. 1998;90(2):87–92. [PMC free article] [PubMed] [Google Scholar]
  • 24.Health Canada, Alberta HealthWellness. Alberta Aboriginal HIV Strategy 2001–2004. Edmonton: Alberta Health and Wellness; 2001. [Google Scholar]
  • 25.Irwin KL, Valdiserri RO, Holmberg SD. The acceptability of voluntary HIV antibody testing in the United States: A decade of lessons learned. AIDS. 1996;10:1707–17. doi: 10.1097/00002030-199612000-00016. [DOI] [PubMed] [Google Scholar]
  • 26.Chadsey D. Prenatal screening program update. The Messenger, College of Physicians and Surgeons of Alberta. 2002;96:5. [Google Scholar]

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