Abstract
Objective
To determine the extent to which provincial recommendations, reported regional prevalence rates and perceived local prevalence rates of HIV in pregnancy influence a physician’s decision to routinely offer prenatal screening for HIV.
Design and Methods
A random sample of 5,052 family physicians and obstetricians were surveyed by mail. Logistic regression was used to explore the relationships among the variables of interest.
Results
The response rate was 61%. Of these, 69.2% provided prenatal care and were included in the analysis. Physicians were more likely to routinely offer HIV testing if they practiced in provinces with recommendations that supported the universal offer of a test (O.R.=5.80), independent of living in a region with an estimated prevalence rate exceeding 5/10,000 (O.R.=1.76), or the perception that the infection rate in their practice justified universal counselling of pregnant women (O.R.=10.41).
Conclusions
Provincial recommendations supporting universal HIV testing in pregnancy are reflected in physician practice.
Résumé
Objectif
Nous avons voulu déterminer dans quelle mesure les recommandations provinciales, les taux de prévalence régionaux déclarés et les taux de prévalence locaux perçus du VIH durant la grossesse incitent les médecins à proposer systématiquement un dépistage prénatal du VIH.
Conception et méthode
Nous avons posté un questionnaire à un échantillon aléatoire de 5 052 médecins de famille et obstétriciens et analysé par régression logistique les liens entre les diverses variables.
Résultats
Le taux de réponse a été de 61 %. Nous avons inclus dans l’analyse les 69,2 % de répondants qui dispensaient des soins prénatals. Les médecins avaient plus tendance à proposer systématiquement le test de sérodiagnostic du VIH s’ils exerçaient dans les provinces qui recom-mandent un dépistage universel (rapport de cotes [RC] = 5,80), qu’ils vivent ou non dans une région dont les taux de prévalence estimatifs sont supérieurs à 5 p. 10 000 (RC = 1,76), et qu’ils jugent ou non que le taux d’infection dans leur clientèle justifie de proposer du counselling à toutes les femmes enceintes (RC = 10,41).
Conclusions
Les recommandations provinciales à l’appui du dépistage universel du VIH durant la grossesse se traduisent donc dans les décisions des médecins.
Footnotes
Formerly of the Department of Emergency Medicine, Queen’s University, Canada
Formerly of the Department of Community Health and Epidemiology, Queen’s University, Canada
Formerly Médecin-conseil, Direction de la santé publique, de la planification et de l’évaluation Régie régionale et des services sociaux du Bas-Saint-Laurent, and Department of Epidemiology and Biostatistics, n]McGill University, c]Montreal, s]Quebec, p]Canada
Acknowledgements: Funding for this study was provided by Health Canada and the Physicians’ Services Incorporated of Ontario. The authors acknowledge the help and support of Dr. Marshall Godwin, Debbie Dowker and Tanya Flanagan; and thank Dr. Lee Lior, of the Bureau of HIV/AIDS and STDs, Laboratory Centre for Disease Control, Health Canada for her assistance in obtaining seroprevalence estimates.
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