Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
Matern Child Health J. 2011 Jan;15(1):115-21. doi: 10.1007/s10995-009-0562-2.
The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists recommend routine rapid HIV testing in labor and delivery (L&D) for women with undocumented HIV status using an opt-out approach. Identifying factors associated with declining a rapid HIV test in L&D will be helpful in developing strategies to improve rapid HIV testing uptake. Data from the Mother-Infant Rapid Intervention at Delivery study were analyzed. Women ≥24 weeks gestation, in labor, with undocumented HIV status were offered rapid HIV testing using informed consent. Women who declined rapid HIV testing (decliners) but agreed to be interviewed were compared to women who accepted testing (acceptors). 102 decliners and 478 acceptors met inclusion criteria for analysis. Decliners of rapid HIV testing were more likely to have had prenatal care (PNC), after adjusting for age, Hispanic ethnicity, high-school education and city of enrollment (adjusted OR 2.4, 95% CI 1.06-5.58). Having had PNC was collinear with prior HIV education and previous offer of an HIV test during the current pregnancy, so these factors were not part of the model. During PNC, standard informed consent may involve discussions that negatively affect later uptake of testing in L&D. Therefore an opt-out approach to testing may improve testing rates. Furthermore, decliners may have felt that testing in L&D was redundant because of previous testing during PNC; however, if previous testing occurred, this was undocumented at L&D. Documentation and timely communication of HIV status is critical to provide appropriate HIV prophylaxis.
疾病控制与预防中心和美国妇产科医师学会建议对未记录 HIV 状况的产妇采用默认同意的方式，在分娩时常规进行快速 HIV 检测。明确与产妇拒绝快速 HIV 检测相关的因素，有助于制定提高快速 HIV 检测率的策略。对母婴快速干预分娩研究的数据进行了分析。对≥24 周妊娠、临产且未记录 HIV 状况的妇女，在知情同意的情况下进行快速 HIV 检测。拒绝快速 HIV 检测（拒绝者）但同意接受采访的妇女与接受检测的妇女（接受者）进行了比较。102 名拒绝者和 478 名接受者符合分析的纳入标准。在调整年龄、西班牙裔、高中学历和入组城市后，拒绝快速 HIV 检测的妇女更有可能接受过产前保健（PNC）（调整后的 OR 2.4，95%CI 1.06-5.58）。有 PNC 与之前的 HIV 教育和本次妊娠期间之前提供的 HIV 检测呈正相关，因此这些因素未纳入模型。在 PNC 期间，标准的知情同意可能涉及一些讨论，这些讨论可能会对之后的 L&D 检测产生负面影响。因此，采用默认同意的检测方式可能会提高检测率。此外，拒绝者可能认为在 L&D 进行检测是多余的，因为之前在 PNC 期间已经进行了检测；然而，如果之前进行了检测，这在 L&D 期间没有记录。记录和及时沟通 HIV 状况对于提供适当的 HIV 预防措施至关重要。
