COMPLIANCE WITH VOLUNTARY PRENATAL HIV TESTING IN A LARGE HEALTH MAINTENANCE ORGANIZATION (HMO)

Results of a recent national clinical trial show that maternal-to-feta l transfer of HIV can be decreased threefold by prenatal, intrapartum, and neonatal treatment. The question is whether to make prenatal HIV testing compulsory or to encourage voluntary testing. Kaiser Permanent e Northern California (KPNC), which has 2.5 million members, is part o f a large health maintenance organization (HMO). In 1994, KPNC cared f or 32,700 prenatal patients; 16,500 (50%) agreed to voluntary HIV test ing. Compliance with testing ranged from 0% to 92% among the 31 KPNC l ocations. A study done by telephone survey identified three main facto rs favoring success of voluntary HIV screening: the ease and accessibi lity of HIV testing, a designated educator, and the presence of a regi stered nurse on the counseling team. In 1995, following feedback to th e 31 facilities of the 1994 results, compliance rose to 19,800 of 31,3 00 prenatal patients (63%). KPNC, by encouraging counseled voluntary s creening and following known positive cases, hopes to identify, track, and offer treatment options to all HIV-positive prenatal patients.