Tookey P A, Gibb D M, Ades A E, Duong T, Masters J, Sherr L, Peckham C S, Hudson C N
Department of Epidemiology and Public Health, Institute of Child Health, London, United Kingdom.
J Med Screen. 1998;5(3):133-6. doi: 10.1136/jms.5.3.133.
In 1996 only 13.5% of previously undiagnosed HIV infected women were detected in pregnancy. In this study, all 265 maternity units in the United Kingdom were surveyed to determine the relation between screening strategy, uptake of testing, and detection rate.
Data on HIV screening strategy and uptake of testing were collected in 1997 by postal questionnaire. The proportion of women with previously undiagnosed HIV infection identified during pregnancy (detection rate) was calculated using data from national obstetric HIV surveillance and unlinked anonymous seroprevalence studies.
239 (90%) units responded; 25 of these (10%) had a universal offer strategy, 89 (37%) a selective offer, and 125 (52%) tested only women who requested it. All selective units offered testing to injecting drug users, but only 26% to women who had lived abroad in high prevalence areas. Uptake was over 10% in only eight units, all with a universal strategy, and in 76% of selective units it was below 0.1%. The detection rate was 14.7% in universal units, 7.8% in selective units, and 7.7% in on request units. In universal units, detection increased by 6.3% (95% confidence interval 3.7% to 8.8%) for every 10% increase in uptake of testing. There was evidence of both selective presentation for testing and avoidance of testing among infected women.
All current antenatal HIV testing strategies fail to identify most infected women. Universal offer strategies achieve a very low uptake and a poor detection rate. Units with selective strategies tend to test only a minority of women at high risk and do not target all the main high risk groups.
1996年，仅有13.5%先前未被诊断出感染艾滋病毒的女性在孕期被检测出来。在本研究中，对英国所有265个产科单位进行了调查，以确定筛查策略、检测接受率与检测率之间的关系。
1997年通过邮政问卷收集了关于艾滋病毒筛查策略和检测接受率的数据。利用国家产科艾滋病毒监测和非关联匿名血清流行率研究的数据，计算出孕期发现的先前未被诊断出感染艾滋病毒的女性比例（检测率）。
239个（90%）单位做出了回应；其中25个（10%）采用普遍提供检测策略，89个（37%）采用选择性提供检测策略，125个（52%）仅对要求检测的女性进行检测。所有采用选择性策略的单位都为注射吸毒者提供检测，但仅26%为曾在高流行地区居住过的女性提供检测。只有8个单位的接受率超过10%，这些单位均采用普遍提供检测策略，在76%采用选择性策略的单位中，接受率低于0.1%。采用普遍提供检测策略的单位检测率为14.7%，采用选择性策略的单位为7.8%，采用按需检测策略的单位为7.7%。在采用普遍提供检测策略的单位中，检测接受率每增加10%，检测率就提高6.3%（95%置信区间为3.7%至8.8%）。有证据表明，受感染女性中存在选择性接受检测和回避检测的情况。
目前所有的产前艾滋病毒检测策略都无法识别大多数受感染女性。普遍提供检测策略的接受率极低，检测率也很差。采用选择性策略的单位往往只对少数高危女性进行检测，并未针对所有主要高危群体。
