Sherr Lorraine, Fox Zoe, Lipton Michelle, Whyte Patricia, Jones Patricia, Harrison Ursula
Royal Free and University College Medical School, UCL, London, UK.
AIDS Care. 2006 Apr;18(3):183-8. doi: 10.1080/09540120500456599.
This study sets out to examine how routine offers of HIV testing for pregnant women in ante-natal (prenatal) clinics are managed over time. Data was collected over two time periods (2002, 2004) from all women booking clinics at three London hospitals. Data from 3,560 women, comprising 2,710 in 2002 (time 1) and 850 in 2004 (time 2) were gathered. Uptake of HIV testing, demographic variables, HIV-associated risks, pregnancy variables and uptake of other ante-natal tests were monitored. In the later study, details of partner testing and time spent discussing HIV was monitored. HIV test uptake with routine offer (RCT) was high. There was a significant increase in HIV testing over time from 85 to 91% (p<0.0001). In 2004, significantly more women had been previously tested for HIV (25 versus 41%, p<0.0001), more women refused all other ante-natal tests (rubella [0 versus 4% p<0.0001], syphilis [1 versus 5%, p<0.0001], Haemoglobin [1 versus 3%, p<0.0001], Down's syndrome [0 versus 13%, p<0.0001] and hepatitis B [1 versus 5%, p<0.0001]). Significantly less women refused HIV test (15 versus 9%, p<0.0001). Initially, HIV was the most frequently refused test (15%), whereas at time 2 Down's syndrome tests were most frequently declined. At time 1, 2% declined any test. By time 2, 14% of the sample declined any test (p<0.0001). Three percent of women had an established HIV risk at time 1 and 6% at time 2. Women with risk factors were significantly less likely to accept testing at time 2, but not at time 1 or not overall. Multivariable analysis was carried out to look at predictors of opting in and opting out of testing. At time 2 HIV test uptake was more likely if less than 3 min was spent discussing it (chi2=9.3, p=0.002). This information was not available at time 1. HIV testing in ante-natal care can be sustained over time. Challenges for the future relate to complex cases, test declining, ensuring that women with risk factors do not systematically decline and providing skills for midwives or referral pathways to deal with more demanding cases. It has been possible to normalise HIV testing. Women have responded with high HIV test uptake, but are also questioning other tests which were previously routinely offered.
本研究旨在探讨随着时间推移，产前诊所针对孕妇的常规艾滋病毒检测是如何开展的。在两个时间段（2002年、2004年）收集了伦敦三家医院所有预约诊所的女性的数据。收集了3560名女性的数据，其中2002年（时间1）有2710名，2004年（时间2）有850名。监测了艾滋病毒检测的接受情况、人口统计学变量、与艾滋病毒相关的风险、妊娠变量以及其他产前检查的接受情况。在后期研究中，监测了伴侣检测的细节以及讨论艾滋病毒相关问题所花费的时间。常规提供（随机对照试验）的艾滋病毒检测接受率很高。随着时间的推移，艾滋病毒检测率从85%显著上升至91%（p<0.0001）。2004年，之前接受过艾滋病毒检测的女性明显更多（25%对41%，p<0.0001），拒绝所有其他产前检查的女性更多（风疹[0%对4%，p<0.0001]、梅毒[1%对5%，p<0.0001]、血红蛋白[1%对3%，p<0.0001]、唐氏综合征[0%对13%，p<0.0001]和乙型肝炎[1%对5%，p<0.0001]）。拒绝艾滋病毒检测的女性明显更少（15%对9%，p<0.0001）。最初，艾滋病毒检测是最常被拒绝的检查（15%），而在时间2，唐氏综合征检测最常被拒绝。在时间1，2%的人拒绝任何检查。到时间2，14%的样本拒绝任何检查（p<0.0001）。时间1时3%的女性有确定的艾滋病毒风险，时间2时为6%。有风险因素的女性在时间2接受检测的可能性明显更低，但在时间1或总体上并非如此。进行了多变量分析以研究选择接受和拒绝检测的预测因素。在时间2，如果讨论艾滋病毒检测的时间少于3分钟，接受艾滋病毒检测的可能性更大（卡方=9.3，p=0.002）。时间1时没有这些信息。产前护理中的艾滋病毒检测可以随着时间的推移持续进行。未来的挑战涉及复杂病例、拒绝检测、确保有风险因素的女性不会系统性地拒绝检测，以及为助产士提供技能或提供转诊途径以处理更棘手的病例。已经有可能使艾滋病毒检测常态化。女性对艾滋病毒检测的接受率很高，但也在质疑之前常规提供的其他检查。
