Prevalence of Prenatal HIV Screening in Massachusetts: Examining Patterns in Prenatal HIV Screening Using the Massachusetts Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2016

Abstract

Prenatal HIV screening is critical to eliminate mother-to-child (MTC) HIV transmission. Although Massachusetts (MA) has near-zero MTC transmission rates, recent trends in statewide prenatal HIV testing are unknown. This study examined variations in prenatal HIV screening across race/ethnicity, socioeconomic status, and prenatal care settings in MA, in the period following national and state-level changes in guidance encouraging routine prenatal HIV testing. According to the MA Pregnancy Risk Assessment Monitoring System (PRAMS) data, 68.3% of pregnant women in MA were screened for HIV between 2007 and 2016. There were significant differences in prenatal screening rates across race/ethnicity, with 83.38% of Black non-Hispanic (NH), 85.5% of Hispanic women, and 62.4% of White NH women reporting being tested for HIV at some point during their pregnancy ( P <.0001). Multivariate regression found that differences in screening were explained by race/ethnicity, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) status, prenatal care site, type of insurance, nativity, and marital status. Annual rates of prenatal HIV screening did not change significantly in MA from 2007 to 2016 ( P = .27). The results of the analysis revealed that prenatal HIV screening rates differ based on race/ethnicity, with higher rates in Black NH and Hispanic women when compared to White NH women. The racial disparities in prenatal HIV screening and lack of universal screening in MA raises questions about the effectiveness of the state's approach.

Universal Repeat Screening for Human Immunodeficiency Virus in the Third Trimester of Pregnancy

“…Repeat screening has not been well-studied in lower incidence settings, but only 82.4% of pregnant individuals nationally receive any prenatal screen for HIV infection, 43 and as low as 68.3% of patients are screened on a state-by-state basis. 44…”

“…Repeat screening has not been well- studied in lower incidence settings, but only 82.4% of pregnant individuals nationally receive any prenatal screen for HIV infection, 43 and as low as 68.3% of patients are screened on a state-by-state basis. 44 Accurately modeling HIV screening pathways to reflect the reality of clinical implementation is challenging. This is partially due to imperfect adherence to guidelines as well as barriers to care among individuals at greatest risk for infection.…”