FACTORS AFFECTING UPTAKE OF ANTENATAL HIV TESTING IN LONDON - RESULTSOF A MULTICENTER STUDY

Objectives: To measure the uptake of antenatal HIV testing and determi ne its relation to risk of HIV and to screening practices. Design: Mul ticentre prospective questionnaire study. Subjects: Pregnant women att ending six maternity units. Setting: Inner London, 1995-6. Main outcom e measures: Uptake of testing by risk factors for HIV ethnicity, and f actors about the antenatal interview. Results: All units had a ''unive rsal offer'' policy for HIV testing. In five units forms were complete d for 18 791 (88%) of 21 247 pregnant women. The sixth unit, where the response rate was too low to assess uptake, was excluded from the ana lysis. Uptake ranged from 3.4% to 51.2% (overall 22.9%), in parallel w ith detection of previously undiagnosed infection in pregnant women (4 .9-60%). Controlling for unit, uptake was higher among the 7% who disc losed risk factors. Among those at low risk, uptake varied by ethnic g roup (South Asian women 9%; Latin American and Mediterranean women 33% ). The relation between uptake and HIV risk category varied greatly ac ross units. Despite increased HIV seroprevalence in black African wome n, uptake was similar in this group to that among women at low risk (2 4%). Uptake increased 2.1-fold if HIV transmission was discussed. Midw ives reported spending 7 (2-15) minutes discussing HIV issues. Conclus ions: Uptake of HIV testing was unacceptably low in all units, with ma ternity unit the strongest predictor. New approaches to antenatal HIV testing are urgently required and uptake should be audited routinely.