Karolinska Institutet, Department of Public Health Sciences, Division of Global Health, Stockholm, Sweden.
BMC Public Health. 2011 Mar 8;11:151. doi: 10.1186/1471-2458-11-151.
An 'opt-out' policy of routine HIV counseling and testing (HCT) is being implemented across sub-Saharan Africa to expand prevention of mother-to-child transmission (PMTCT). Although the underlying assumption is that pregnant women in rural Africa are able to voluntarily consent to HIV testing, little is known about the reality and whether 'opt-out' HCT leads to higher completion rates of PMTCT. Factors associated with consent to HIV testing under the 'opt-out' approach were investigated through a large cross-sectional study in Kenya.
Observations during HIV pre-test information sessions were followed by a cross-sectional survey of 900 pregnant women in three public district hospitals carrying out PMTCT in the Busia district. Women on their first antenatal care (ANC) visit during the current pregnancy were interviewed after giving blood for HIV testing but before learning their test results. Descriptive statistics and multivariate regression analysis were performed.
Of the 900 women participating, 97% tested for HIV. Lack of testing kits was the only reason for women not being tested, i.e. nobody declined HIV testing. Despite the fact that 96% had more than four earlier pregnancies and 37% had been tested for HIV at ANC previously, only 17% of the women surveyed knew that testing was optional. Only 20% of those surveyed felt they could make an informed decision to decline HIV testing. Making an informed decision to decline HIV testing was associated with knowing that testing was optional (OR = 5.44, 95%CI 3.44-8.59), not having a stable relationship with the child's father (OR = 1.76, 95%CI 1.02-3.03), and not having discussed HIV testing with a partner before the ANC visit (OR = 2.64 95%CI 1.79-3.86).
High coverage of HIV testing appears to be achieved at the cost of pregnant women not understanding that testing is optional. Good quality HIV pre-test information is central to ensure that pregnant women understand and accept the reasons for testing and will thus come back to collect their test results, an important prerequisite for completing PMTCT for those who test HIV-positive.
为了扩大预防母婴传播（PMTCT），撒哈拉以南非洲正在实施一项常规艾滋病毒咨询和检测（HCT）的“选择退出”政策。尽管其基本假设是，非洲农村的孕妇能够自愿同意进行艾滋病毒检测，但对于实际情况以及“选择退出”HCT 是否会导致更高的 PMTCT 完成率知之甚少。通过在肯尼亚进行的一项大型横断面研究，调查了在“选择退出”方法下同意艾滋病毒检测的相关因素。
在 HIV 检测前信息会议期间进行观察，然后对布西亚地区三家开展 PMTCT 的公立区医院的 900 名孕妇进行横断面调查。目前怀孕的孕妇在首次产前保健（ANC）就诊时接受 HIV 检测后，在得知检测结果之前接受采访。进行描述性统计和多变量回归分析。
900 名参与的女性中，97%接受了 HIV 检测。没有检测试剂盒是唯一导致女性未接受检测的原因，即没有人拒绝 HIV 检测。尽管 96%的女性之前已经生育了超过 4 个孩子，37%的女性之前在 ANC 时已经接受过 HIV 检测，但只有 17%的女性调查知道检测是可选的。只有 20%的被调查者认为他们可以做出明智的决定，拒绝 HIV 检测。做出明智的决定拒绝 HIV 检测与知道检测是可选的相关（OR = 5.44，95%CI 3.44-8.59），与孩子父亲的关系不稳定（OR = 1.76，95%CI 1.02-3.03），并且在 ANC 就诊前未与伴侣讨论 HIV 检测（OR = 2.64 95%CI 1.79-3.86）。
高覆盖率的 HIV 检测似乎是以孕妇不理解检测是可选的为代价实现的。高质量的 HIV 检测前信息对于确保孕妇了解并接受检测的原因至关重要，这将使她们回来领取检测结果，这是对那些 HIV 检测呈阳性的人完成 PMTCT 的重要前提。
