Characteristics associated with lack of HIV testing during pregnancy and delivery in 36 U.S. states,2004

Abstract

The Centers for Disease Control and Prevention and the American Congress of Obstetricians and Gynecologists recommend universal prenatal HIV testing to prevent perinatal HIV transmission in the U.S.; since the 1990s perinatal HIV transmission has declined. In 2006, 74% of women with a recent live birth reported testing for HIV prenatally or at delivery. We used Pregnancy Risk Assessment Monitoring System data from 36 states and New York City from 2004 to 2013 (N = 387,424) to assess characteristics associated with lack of self-reported testing and state-to-state variability in these associations. Overall, 75.2% (95% confidence interval [CI] 75.0–75.5) of women with a recent live birth reported an HIV test. There were significant differences in testing prevalence by state, ranging from 91.8% (95% CI 91.0–92.6) in New York to 42.3% (95% CI 41.7–43.5) in Utah. In adjusted analysis, characteristics associated with no reported testing included being married, white, non-Hispanic, multiparous, not smoking during pregnancy, and having neither Medicaid nor Special Supplemental Nutritional Program for Women, Infants, and Children. White married women were 57% (adjusted prevalence ratio [aPR] 1.57, 95% CI 1.52–1.63) more likely to report no test compared to white unmarried women. Multiparous married women were 57% (aPR 1.57, 95% CI 1.51–1.64) more likely to report no test compared to multiparous unmarried women. Women who were married, white, non-Hispanic, and multiparous women were 23% less likely to be tested than other women combined. Marital status was significantly associated with lower prevalence of testing in 35 of the 37 reporting areas, and race was significant in 30 of 35 states with race information. The prevalence of reported HIV testing during pregnancy or at delivery remains below 80%. Opportunities exist to increase HIV testing among pregnant women, particularly among certain subpopulations.

Keywords

HIV pregnancy prenatal testing screening prevention mother-to-child transmission Pregnancy Risk Assessment Monitoring System disparities

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References

Lindegren

Byers

Thomas

et al . Trends in perinatal transmission of HIV/AIDS in the US. JAMA 1999; 282: 531–538.

Taylor

Nesheim

Zhang

et al . Estimated perinatal HIV infection among infants born in the United States, 2002–2013. JAMA Pediatr 2017; 171: 435–442.

The American Congress of Obstetricians and Gynecologists. Prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Committee Opinion no.: 304. Obstet and Gynecol 2004; 104: 1119.

The American Congress of Obstetricians and Gynecologists. Prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Committee Opinion no.: 635. Obstet Gynecol 2015; 125: 1544–1547.

Centers for Disease Control and Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-related settings. MMWR 2006; 55: 1–17.

Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States, http://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf (accessed 13 January 2017).

Townsend

Cortina-Borja

Peckham

et al . Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000–2006. AIDS 2008; 22: 973–981.

Immergluck

Cull

Schwartz

et al . Cost-effectiveness of universal compared with voluntary screening for human immunodeficiency virus among pregnant women in Chicago. Pediatrics 2000; 105: 1–9.

Fitz Harris

Taylor

Zhang

et al . Factors associated with human immunodeficiency virus screening of women during pregnancy, labor, and delivery, United States, 2005– 2006. Matern Child Health J 2014; 18: 648–656.

10.

Anderson

Sansom

HIV testing among U.S. women during prenatal care: findings from the 2002 national survey of family growth. Matern Child Health J 2006; 10: 413–417.

11.

Fitz Harris

Johnson

Nesheim

et al . Self-reported prenatal HIV testing and the impact of HIV testing laws, 2004–2011. Sex Transm Dis. Epub ahead of print 26 February 2018. DOI: 10.1097/OLQ.0000000000000821.

12.

PRAMS www.cdc.gov/PRAMS. (accessed 28 February 2017).

13.

National Center for Health Statistics, https://www.cdc.gov/nchs/index.htm (accessed 29 February 2017).

14.

Shulman

Gilbert

Lansky

The Pregnancy Risk Assessment Monitoring System (PRAMS): current methods and evaluation of 2001 response rates. Public Health Rep 2006; 121: 74–83.

15.

Grigorescu

D’Angelo

Harrison

et al . Implementation science and the pregnancy risk assessment monitoring system. J Women’s Health 2014; 23: 989–994.

16.

Kessner

Singer

Kalk

et al.

Infant death: an analysis by maternal risk and health care. Chapter 2. Washington, DC: Institute of Medicine and National Academy of Sciences, 1973.

17.

Bieler

Brown

Williams

et al . Estimating model-adjusted risks, risk differences, and risk ratios from complex survey data. Am J Epidemiol 2010; 171: 618–623.

18.

Chow

Wright

Bolan

Estimation of prenatal screening rates for chlamydia, syphilis, and HIV among low-income women, California, 2007. Sex Transm Infect 2011; 87: P1-S6.24.

19.

Janes

Beard

Tao

et al . Perinatal screening for STIs in the USA: adherence to preventive screening recommendations for HIV and syphilis among the commercially insured (2008). Sex Transm Infect 2011; 87: P1-S6.20.

20.

Conrad

Bradley

Broz

et al . Community outbreak of HIV infection linked to injection drug use of Oxymorphone – Indiana, 2015. MMWR 2015; 64: 443–444.

21.

HIV. Healthy People 2020. U.S. Department of Health and Human Services/Office of Disease Prevention and Promotion, 2010, https://www.healthypeople.gov/2020/topics-objectives/topic/hiv/objectives (accessed 28 February 2017).

22.

Mahajan

Kinsler

Cunningham

et al . Does the centers for disease control and prevention’s recommendation of opt-out HIV screening impact the effect of stigma on HIV test acceptance? AIDS Behav 2016; 20: 107–114.

23.

Dietz

Bombard

Mulready-Ward

et al . Validation of self-reported maternal and infant health indicators in the pregnancy risk assessment monitoring system. Matern Child Health J 2014; 18: 2489–2498.

24.

Tan

Lampe

Danner

et al . Factors associated with declining a rapid human immunodeficiency virus test in labor and delivery. Matern Child Health J 2011; 15: 115–121.

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Characteristics associated with lack of HIV testing during pregnancy and delivery in 36 U.S. states,2004–2013

Abstract

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