IS HIV TESTING IN ANTENATAL CLINICS WORTHWHILE - CAN WE AFFORD IT

Since 0.2-0.4% of pregnant women attending antenatal clinics (ANC) at St Thomas's Hospital are HIV positive, and as the Department of Health (DH) have recommended that universal voluntary HIV testing be made av ailable to women attending ANC in areas of ''known or suspected higher prevalence of HIV infection'', we examined the implications of the DH initiative in an inner London Teaching Hospital as well as in a Gener al Practice involved an shared care. The cost of the programme (pound 148,300 to pound 193,900), 80% of which relates to the need to obtain informed consent, was approximately 2.7-3.5 times that calculated by t he DH. The DH based much of their costing on additional time for couns elling rather than calculating the additional staff required. We estim ated that 25% of women will require specialized counselling since 17% are of African ethnicity and others are injecting drug users or 'worri ed well'. Various means of reducing costs were considered but, until s uch time as explicit, informed consent is no longer considered necessa ry, the above resources will be required. Unless the DH continues to p rovide central direction to Providing Agencies to give priority to the se recommendations and, where necessary, provides additional finding, we fear that this important public health initiative will be unsuccess ful.