HIV testing among pregnant women with prenatal care in the United States: An analysis of the 2011–2017 National Survey of Family Growth

Abstract

Although there has been significant progress in reducing perinatal human immunodeficiency virus (HIV) transmission, the United States is yet to meet the proposed elimination goal of less than one infection per 100,000 live births. Failure to screen all pregnant women for HIV as recommended by the Centers for Disease Control and Prevention can result in missed opportunities for preventing vertical transmission of HIV with antiretroviral drugs. Using the 2011–2017 National Survey of Family Growth, this study examined HIV testing among pregnant women during prenatal care. We estimated the weighted proportion of self-reported HIV testing among women whose last pregnancy ended within 12 months prior to the interview. Logistic regression models were used to determine the factors associated with HIV testing. Of the 1566 women included in the study, 76.4% (95% confidence intervals [CI] = 72.8–80.0) reported receiving an HIV test during prenatal care. In the multivariable regression model, high school diploma (adjusted odds ratio [aOR] = 1.9, 95% CI = 1.1–3.1), two completed pregnancies (aOR = 1.7, 95% CI = 1.1–2.7), health insurance coverage in the last 12 months (aOR = 1.6, 95% CI = 1.0–2.6), Hispanic race/ethnicity (aOR = 2.8, 95% CI = 1.8–4.4), and non-Hispanic black race/ethnicity (aOR = 2.2, 95% CI = 1.3–3.8) were associated with higher odds of reporting being tested for HIV. However, household income of 300% or more of the federal poverty level (aOR = 0.6, 95% CI = 0.3–0.9) and urban residence (aOR = 0.5, 95% CI = 0.3–0.9) were associated with lower odds of reporting HIV testing. These findings suggest that HIV testing among pregnant women during prenatal care is not universal and may affect achieving the goal of elimination of mother-to-child transmission of HIV in the United States.

Socioeconomic inequalities in the HIV testing during antenatal care: evidence from Indian demographic health survey, 2015–16

“…This finding revealed that poverty is significant influencing factor associated with HIV testing during ANC. Our findings, which showed that there is significant inequality in HIV testing during ANC between richer and poorer quintile of women, are consistent with findings from low -middle-income countries [ 20 , 50 , 51 ]. We found that education, place of residence, regular exposure of mass media, and comprehensive knowledge of HIV/AIDS made a considerable contribution to observed socio-economic inequalities in HIV testing during antenatal period.…”

HIV testing during pregnancy among women with a recent live birth—Seven US States, 2016–2019

“…More details about the PRAMS surveillance system have been described elsewhere https://www.cdc.gov/prams/index.htm. 16 This report is a secondary data analysis of data collected by seven states (Alabama, Alaska, Arkansas, Maryland, Massachusetts, Mississippi, and Nebraska) that asked an optional question about the receipt of HIV testing during pregnancy and achieved a targeted weighted annual response rate of at least ⩾ 55% (2016 and 2017) or ⩾ 50% (2018 and 2019) on their PRAMS survey in one or more of the study years. State data were included for each year the state achieved the required weighted annual response rate.…”

“…More details about the PRAMS surveillance system have been described elsewhere https://www.cdc.gov/prams/index.htm . 16 …”

Improved antenatal HIV screening coverage with a switch from opt-in to opt-out testing in the northern region of New Zealand

“…We have addressed one area, for women who already access antenatal screening, whereas a comprehensive program should ensure all women can access screening during pregnancy or at delivery. 11,12 During the consultation it was apparent that practices surrounding HIV screening in pregnancy are not transparent to the community sector and policy makers and they may not reflect current bestpractice; therefore, we strongly recommend national oversight of this area, starting with an audit of current antenatal HIV testing policy and uptake in all localities (including ethnicity data), and an unequivocal move to national opt-out testing.…”