Some OBs unclear on HIV testing requirements

NEW YORK (Reuters Health) - Although virtually all obstetrician-gynecologists recommend HIV testing to all their pregnant patients, some are unaware of their state requirements for recommending such testing, according to a report in the Obstetrics & Gynecology.

Several organizations, including the Centers for Disease Control and Prevention, have recommended that all pregnant women be screened for HIV, using an opt-out approach, as part of routine prenatal care, the authors explain.

With the opt-out testing strategy, the woman tested unless she explicitly refuses. She is provided information on HIV and told that a test will be performed as part of a battery of standard tests. She is also informed that she has the right to decline testing.

The opt-in testing approach requires an explicit request for an HIV test. After a woman has received HIV information, she is asked if she wants an HIV test. She is tested only if she specifically agrees and, in most cases, signs and an informed consent form.

Dr. Jay Schulkin and colleagues from the American College of Obstetricians and Gynecologists, Washington, DC surveyed obstetrician-gynecologists regarding HIV knowledge. A total of 1,032 questionnaires were sent out and 582 were returned.

All but 3 percent of obstetrician-gynecologists reported that they recommend HIV testing to all of their pregnant patients, the authors report, though nearly three quarters of obstetrician-gynecologists considered 5 percent or fewer of their pregnant patients to be at high risk for HIV infection.

Obstetrician-gynecologists were fairly evenly divided as to whether they tested their pregnant patients for HIV using the opt-in approach (52 percent) or the opt-out approach (48 percent).

Just over half the obstetrician-gynecologists (57 percent) reported using the HIV testing approach required in their states, the researchers note, while 43 percent reported using an approach not consistent with their state's regulation.

Nearly one third of obstetrician-gynecologists said they did not know if their state required HIV testing during pregnancy.

Most obstetrician-gynecologists responding to the survey reported that they provide pretest counseling before HIV testing (73.7 percent) and post-test counseling (84.6 percent).

"The results of this study suggest that obstetrician-gynecologists may benefit from additional information that could improve their knowledge and practice regarding HIV screening," the investigators write.

"Although most respondents report being at least moderately knowledgeable about HIV during pregnancy and report recommending HIV testing to all pregnant patients, they may need to be more aggressive in following up with patients who decline HIV testing."

SOURCE: Obstetrics & Gynecology, November 2007