Prenatal HIV Testing and the Impact of State HIV Testing Laws, 2004 to 2011

FitzHarris, Lauren F.; Johnson, Christopher H.; Nesheim, Steven; Taylor, Allan W.; Harrison, A; Ruffo, Nan; Burley, Kim; House, L. Duane; Koumans, Emilia H.

doi:10.1097/olq.0000000000000821

Cited by 8 publications

(11 citation statements)

References 16 publications

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“…13,18 Research findings have shown that patient-level factors such as fear, confidentiality and stigma, and low perceived risks, inhibit pregnant women from getting HIV tests in the United States. 33,36,37 Barriers also exist at institutional level 38 such as absence of hospital policies for testing pregnant women, 14 lack of supporting state laws or regulations, 39 providers not offering routine screening to pregnant women, 40 or only screen populations at higher risk of HIV. 41,42 Some of these reasons may partially explain the significant differences in sociodemographic characteristics in our study.…”

Section: Discussionmentioning

confidence: 99%

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

2020

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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.

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Section: Discussionmentioning

confidence: 99%

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

2020

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“…The prevalence of HIV testing varied by state and ranged from 42.6% (95% CI 41.7–43.5) in Utah to 91.8% (95% CI 91.0–92.6) in New York (NY); an analysis of annual state HIV testing rates is provided elsewhere. 11 Nationally, the prevalence of HIV testing by year ranged from 71.9% (95% CI 71.2–72.7) in 2013 to 77.5% (95% CI 76.878.1) in 2005. Compared to unmarried women (85.3%; 95% CI 85.1–85.7), fewer married women reported testing (68.8%; 95% CI 68.5–69.1); compared to black women (90.0%; 95% CI 89.6–90.4) or women of other race (77.4%; 95% CI 76.8–78.0), fewer white women (72.5%; 95% CI 71.2–71.8) reported testing.…”

Section: Resultsmentioning

confidence: 99%

“…Among women with a recent live birth who participated in PRAMS during 2004–2013, the overall rate of HIV testing during pregnancy or at delivery was 75%, which is similar to the rate found in 2006, 9 similar to two smaller analyses using claims data from 2007 (62%) and 2008 (74.1%) that also examined syphilis testing, 18,19 and similar annually to the year-by-year analysis of 2004–2011 PRAMS data in a companion article. 11 There has been no appreciable change since ACOG released universal testing recommendations in 2004, which were updated in 2008 and in 2015, 4 or since 2004–2006, when CDC revised recommendations on HIV testing to state that all pregnant women should be tested as early as possible during each pregnancy. 3,5…”

Section: Discussionmentioning

confidence: 99%

“…They found that areas where testing rates have increased implemented policy changes, passed laws, or worked with providers on quality initiatives that may have led to increased testing. 11 Areas where HIV testing has remained stable or decreased may benefit from implementing successful activities.…”

Section: Discussionmentioning

confidence: 99%

“…The testing rate has not changed substantially in the last ten years. 11 HIV testing is cost effective and universal testing is recommended by ACOG and CDC; local efforts to implement universal HIV testing may reduce differences in testing rates between subpopulations and further reduce perinatal transmission.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics associated with lack of HIV testing during pregnancy and delivery in 36 U.S. states, 2004–2013

et al. 2018

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The Centers for Disease Control and Prevention and the American Congress of Obstetricians and Gynecologists recommend universal prenatal HIV testing to prevent perinatal HIV transmission in the U.S.; since the 1990s perinatal HIV transmission has declined. In 2006, 74% of women with a recent live birth reported testing for HIV prenatally or at delivery. We used Pregnancy Risk Assessment Monitoring System data from 36 states and New York City from 2004 to 2013 (N = 387,424) to assess characteristics associated with lack of self-reported testing and state-to-state variability in these associations. Overall, 75.2% (95% confidence interval [CI] 75.0-75.5) of women with a recent live birth reported an HIV test. There were significant differences in testing prevalence by state, ranging from 91.8% (95% CI 91.0-92.6) in New York to 42.3% (95% CI 41.7-43.5) in Utah. In adjusted analysis, characteristics associated with no reported testing included being married, white, non-Hispanic, multiparous, not smoking during pregnancy, and having neither Medicaid nor Special Supplemental Nutritional Program for Women, Infants, and Children. White married women were 57% (adjusted prevalence ratio [aPR] 1.57, 95% CI 1.52-1.63) more likely to report no test compared to white unmarried women. Multiparous married women were 57% (aPR 1.57, 95% CI 1.51-1.64) more likely to report no test compared to multiparous unmarried women. Women who were married, white, non-Hispanic, and multiparous women were 23% less likely to be tested than other women combined. Marital status was significantly associated with lower prevalence of testing in 35 of the 37 reporting areas, and race was significant in 30 of 35 states with race information. The prevalence of reported HIV testing during pregnancy or at delivery remains below 80%. Opportunities exist to increase HIV testing among pregnant women, particularly among certain subpopulations.

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