Potential Factors That May Affect Acceptance of Routine Prenatal HIV Testing

• Published in: Canadian Journal of Public Health
• Main Authors: Wang, Fu-Lin, Larke, Bryce, Gabos, Stephan, Schopflocher, Donald, Hanrahan, Anita
• Format: Text
• Language: English
• Published: Springer International Publishing 2005
• Subjects: Article; Canada; First Nations
• Online Access: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6976195/; http://www.ncbi.nlm.nih.gov/pubmed/15682699; https://doi.org/10.1007/BF03404020

BACKGROUND: Despite increasing advocacy for an “opt-out” strategy in routine prenatal HIV screening programs in Canada, no published studies have examined factors that may affect acceptance of prenatal HIV testing. METHODS: We included all pregnant women in Alberta who received prenatal care (N=38,712) and their caregivers (N=2,007) between January 1 and November 30, 2000. Factors associated with non-acceptance of HIV testing in both pregnant women and their caregivers were assessed using multivariate logistic regression. RESULTS: Overall, 1.5% of women declined HIV testing. First Nations women were about twice as likely to decline the test (adjusted odds ratio [OR(adj)] 1.91, 95% CI [1.42–2.58]) compared to non-First Nations women (p<0.001). The proportion also increased with age (χ(2)trend p<0.001) in the general population. In First Nations women, however, most (3.2%) declined in the 20–24 year age group. No significant effect was seen for a socio-economic status marker or for the place of residence. The caregivers of women who declined HIV testing were more likely to be female (OR(adj) 1.56 [1.28–1.89]), midwives (OR(adj) 140.65 [58.61–337.49]), other non-obstetrical medical specialties (OR(adj) 4.92 [1.94–12.47]), and general practitioners (OR(adj) 3.44 [1.87–6.33]). CONCLUSION: In an “opt-out” routine prenatal HIV screening program, the characteristics of both the pregnant women and their caregivers may contribute to the non-acceptance of HIV testing. A higher likelihood of declining HIV testing among First Nations pregnant women and other pregnant women under the care of midwives and female physicians warrants further study.