Testing Practices and Knowledge of HIV Among Prenatal Care Providers in a Low Seroprevalence State

Abstract

As the prevalence of heterosexually transmitted HIV increases among women of childbearing age in the United States, so too does the potential for vertical transmission from mother to child. Early maternal diagnosis and appropriate management are critical to minimizing the risk of perinatal infection. We designed a study to evaluate current prenatal care provider testing practices and knowledge of HIV as it relates to pregnancy in a low seroprevalence state. A written questionnaire was mailed to 642 prenatal care providers in Kentucky. Responses were compared to a similar survey conducted in 1998 and to current federal guidelines for HIV management. Nearly all respondents reported to offer HIV testing to all prenatal patients, demonstrating a marked improvement since 1998 (p < 0.001). However, clinicians did not report adequate follow-up when testing is refused and appear to have limited knowledge of the disease as it relates to pregnancy. Only 9.3% of respondents demonstrated proficiency on two knowledge assessment questions. Those with previous experience treating prenatal patients with HIV were more likely to respond correctly (odds ratio [OR] 3.03; 95% confidence interval [CI] 1.08-8.50). Providers with little experience treating patients with HIV may not possess the basic knowledge required to manage the disease during pregnancy. Additional educational interventions are needed in low seroprevalence areas to ensure the appropriate treatment of all HIV-positive pregnant patients and to minimize the risk of preventable perinatal transmission.

Poverty, unstable housing, and HIV infection among women living in the United States

“…Women account for an estimated 27% of the 1.1 million cases of HIV/AIDS in the United States [3]. Three quarters of HIV infections among women were acquired through heterosexual contact [3], and more than 80% occur in racial and ethnic minorities (African American or Latina) [4].…”

“…Three quarters of HIV infections among women were acquired through heterosexual contact [3], and more than 80% occur in racial and ethnic minorities (African American or Latina) [4]. Overall, HIV infection is the fifth leading cause of death for all US women ages 25 to 34 years and the third leading cause of death in African-American women in that age group [5].…”

HIV Screening Among U.S. Physicians, 1999–2000

“…11 Several local surveys have been published assessing HIV testing practices among prenatal care providers. [12][13][14][15][16] These surveys suggest that prenatal HIV screening has improved over time, and is quite high (Ͼ 90%) in several areas. [12][13][14][15][16] A study of family practice clinicians in Rhode Island and Mississippi found that over 93% of providers would recommend an HIV test to a high-risk patient, yet less than 50% recommend HIV testing to sexually active patients aged 18-50.…”

“…[12][13][14][15][16] These surveys suggest that prenatal HIV screening has improved over time, and is quite high (Ͼ 90%) in several areas. [12][13][14][15][16] A study of family practice clinicians in Rhode Island and Mississippi found that over 93% of providers would recommend an HIV test to a high-risk patient, yet less than 50% recommend HIV testing to sexually active patients aged 18-50. 17 Additionally, in Rhode Island and Mississippi, only 14% and 2% of the surveyed providers reported offering an HIV test to more than 50% of their patient populations, respectively.…”

Knowledge and practice of the prevention of mother-to-child transmission of HIV guidelines amongst doctors and nurses at Odi Hospital, Tshwane District

“…This was not the case in a study by Msiri, Tadesse and Muula (2008), in which 37% of the respondents were not comfortable attending to an HIV-positive pregnant woman in labour. 33 A 2007 study by Olges et al 26 showed correct practices amongst HCWs in managing HIVpositive pregnant women coming for their first antenatal consultation. Furthermore, in this study 81% responded correctly by providing PMTCT intervention to HIV-positive pregnant women at their first antenatal consultation.…”