Increased Uptake of HIV Testing With the Integration of Nurse-Initiated HIV Testing Into Routine Prenatal Care

ArticleinJAIDS Journal of Acquired Immune Deficiency Syndromes 49(5):571-3 · January 2009with13 Reads
DOI: 10.1097/QAI.0b013e31818d5e11 · Source: PubMed
    • ". Nonetheless, there may have been deviations from the assigned consenting script that went unnoticed. Moreover, efforts to optimize the uptake of prenatal HIV testing in this clinical setting were instituted prior to initiation of this study even with the use of more traditional standard pre-test counseling by nurses as we have reported elsewhere. [29] Given the very high acceptance of prenatal HIV testing under non-study conditions at our clinic, our results may not be generalizable to other clinical settings with lower baseline uptake of HIV testing. Similarly, our results may not be generalizable to areas with less developed HIV educational and public health campaigns as compared t"
    [Show abstract] [Hide abstract] ABSTRACT: Background: In the US, an unacceptably high percentage of pregnant women do not undergo prenatal HIV testing. Previous studies have found increased uptake of prenatal HIV testing with abbreviated pre-test counseling, however little is known about patient decision making, testing satisfaction and knowledge in this setting. Methodology/findings: A randomized-controlled, non-inferiority trial was conducted from October 2006 through February 2008 at San Francisco General Hospital (SFGH), the public teaching hospital of the City and County of San Francisco. A total of 278 English- and Spanish-speaking pregnant women were randomized to receive either abbreviated or standard nurse-performed HIV test counseling at the initial prenatal visit. Patient decision making experience was compared between abbreviated versus standard HIV counseling strategies among a sample of low-income, urban, ethnically diverse prenatal patients. The primary outcome was the decisional conflict score (DCS) using O'Connor low-literacy scale and secondary outcomes included satisfaction with test decision, basic HIV knowledge and HIV testing uptake. We conducted an intention-to-treat analysis of 278 women--134 (48.2%) in the abbreviated arm (AA) and 144 (51.8%) in the standard arm (SA). There was no significant difference in the proportion of women with low decisional conflict (71.6% in AA vs. 76.4% in SA, p = .37), and the observed mean difference between the groups of 3.88 (95% CI: -0.65, 8.41) did not exceed the non-inferiority margin. HIV testing uptake was very high (97. 8%) and did not differ significantly between the 2 groups (99.3% in AA vs. 96.5% in SA, p = .12). Likewise, there was no difference in satisfaction with testing decision (97.8% in AA vs. 99.3% in SA, p = .36). However, women in AA had significantly lower mean HIV knowledge scores (78.4%) compared to women in SA (83.7%, p<0.01). Conclusions/significance: This study suggests that streamlining the pre-test counseling process, while associated with slightly lower knowledge, does not compromise patient decision making or satisfaction regarding HIV testing. Trial registration: ClinicalTrials.gov NCT00503308.
    Full-text · Article · Apr 2009
  • [Show abstract] [Hide abstract] ABSTRACT: HIV testing policies and practices vary widely across Europe. It is clear that there are individuals who might present late for HIV diagnosis and care within all risk groups, and potentially in any healthcare setting. This article explores the need to ensure earlier identification and treatment of late-presenting patients by reviewing strategies that might be considered. Such strategies could include routine provider-initiated HIV testing of at-risk groups in settings such as sexually transmitted infection clinics, drug dependency programmes or antenatal care. Healthcare providers might also consider routine HIV testing in all healthcare facilities, in settings including emergency and primary care, where local HIV prevalence is above a threshold that should be further evaluated. They should also take advantage of rapid testing technologies and be aware of barriers to HIV testing among specific groups to provide opportunities for testing that are relevant to local communities.
    Article · Jan 2010
  • [Show abstract] [Hide abstract] ABSTRACT: We assessed the extent to which Centers for Disease Control and Prevention (CDC) recommendations have influenced routine HIV testing among Massachusetts community health center (CHC) personnel, and identified specific barriers and facilitators to routine testing. Thirty-one CHCs were enrolled in the study. We compared those that did and did not receive funding support from the federal Ryan White HIV/AIDS Program. An anonymous survey was administered to a maximum five personnel from each CHC, including a senior administrator, the medical director, and three medical providers. Overall, 137 participants completed the survey. Among all CHCs, 53% of administrators reported having implemented routine HIV testing at their CHCs; however, only 33% of medical directors/providers reported having implemented routine HIV testing in their practices (p<0.05). Among administrators, 60% of those from Ryan White-supported CHCs indicated that both they and their CHCs were aware of CDC's recommendations, compared with 27% of administrators from non-Ryan White-supported CHCs. The five most frequently reported barriers to the implementation of routine HIV testing were (1) constraints on providers' time (68%), (2) time required to administer counseling (65%), (3) time required to administer informed consent (52%), (4) lack of funding (35%), and (5) need for additional training (34%). In a multivariable logistic regression model, the provision of on-site HIV testing by nonmedical staff resulted in increased odds of conducting routine HIV testing (odds ratio [OR] = 9.84, 95% confidence interval [CI] 1.77, 54.70). However, the amount of time needed to administer informed consent was associated with decreased odds of providing routine testing (OR=0.21, 95% CI 0.05, 0.92). Routine HIV testing is not currently being implemented uniformly among Massachusetts CHCs. Future efforts to increase implementation should address personnel concerns regarding time and staff availability.
    Full-text · Article · Sep 2011
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