Influence of an “Opt-Out” Test Strategy and Patient Factors on Human Immunodeficiency Virus Screening in Pregnancy

Abstract

OBJECTIVE: To estimate both human immunodeficiency virus (HIV) testing acceptance rates in pregnancy using an opt-out policy and patient characteristics influencing acceptance. METHODS: At the first prenatal visit, HIV testing was offered using an opt-out approach. Reasons for refusing testing were explored. Demographic information was collected on all study subjects. RESULTS: In the prospective portion of the study, 1,140 of 1,233 women (92.5%) accepted testing. Race was predictive of accepting HIV testing, with Asian women significantly less likely (odds ratio [OR] 0.4; 95% confidence interval [CI] 0.3–0.6; P<.001) and Hispanic women significantly more likely (OR 6.9; 95% CI 2.2–22.0; P=.001) to be tested. Although English as a first language, country of birth, and insurance status were not significantly associated with acceptance, women who were fluent in English were more likely to be tested (OR 2.0; 95% CI 1.2–3.3; P=.01). Our testing rates were significantly higher than the provincial average. CONCLUSION: Using an opt-out strategy, HIV testing rates in our clinic were significantly higher than the provincial average. Rates were influenced by race and fluency in English. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , www.clinicaltrials.gov , NCT00393302 LEVEL OF EVIDENCE: II