What are the barriers to offering HIV testing in an antenatal setting? A national study of obstetricians

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Abstract
To investigate factors that influence the antenatal screening practice of obstetricians and identify barriers to the implementation of universal antenatal HIV screening. A survey of all obstetricians registered with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. A questionnaire was mailed to all obstetricians in Australia, followed by two reminders. The overall response rate was 70% (817/1172) and of these 70% always offered an HIV test during pregnancy. Obstetricians offering the test were more likely to female or younger in age. Of respondents who always offered testing, 90% disagreed with only testing women with risk factors compared with only 34% of those who undertook a selective screening approach (adjusted odds ratio, 87.7; 95% confidence interval, 40-192; P = 0.001). Obstetricians who practiced selective screening were influenced by whether the woman had antenatal blood tests prior to her obstetric appointment or a previous negative HIV test. Obstetricians who practiced universal screening were more likely to be concerned about false-positive results. Many obstetricians, irrespective of their screening practice, agreed that many of the components of pretest counseling were inappropriate for the majority of women. A majority of obstetricians in Australia are offering all pregnant women an HIV test. Consideration should be given to tailoring pretest counseling requirements to the antenatal setting. Ongoing education regarding the limitations of selective screening and management of women with false-positive results is also highlighted by this study.