UPTAKE AND ACCEPTABILITY OF ANTENATAL HIV TESTING - RANDOMIZED CONTROLLED TRIAL OF DIFFERENT METHODS OF OFFERING THE TEST

Objective: To determine the uptake and acceptability Of different meth ods of a universal offer of voluntary HIV testing to pregnant women. D esign: Randomised controlled trial involving four combinations of writ ten and verbal communication, followed by the direct offer of a test. The control group receive no information and no direct offer of a test , although testing was available on request. Setting: Hospital antenat al clinic covering most of the population of the city of Edinburgh. Su bjects: 3024 pregnant women booking at tile clinic over a 10 month per iod. Main outcome measures: Uptake af HIV testing and women's knowledg e, satisfaction and anxiety. Results: Uptake rates were 6% for those i n the control group and 35% for those directly offered the test. Neith er the style of leaflet nor the length of discussion had an effect on uptake. Significant independent predictors of uptake were a direct tes t offer; the midwife seen; and being unmarried, previous tested and yo unger age. Knowledge of the specific benefits of testing increased wit h the amount of information given, but neither satisfaction nor anxiet y was affected by the type of offer. Conclusions: The universal offer of HIV testing is not intrusive and is acceptable to pregnant women. A policy of offering the HIV test to all women resulted in higher uptak e and did not increase anxiety or dissatisfaction. Uptake depends more on the midwife than the method of offering the test. Low uptake rates and inadequate detection of HIV infection point to the need to assess a more routine approach to testing.