The purpose of this study was to estimate prenatal human immunodeficiency virus (HIV) screening rates prior to and on admission to labor and delivery (L&D) and to examine factors associated with HIV screening, including hospital policies, with a comparison of HIV and hepatitis B prenatal screening practices and hospital policies. In March 2006, a survey of hospitals (n = 190) and review of paired maternal and infant medical records (n = 4,762) were conducted in 50 US states, DC, and Puerto Rico. Data from the survey and medical record review were analyzed using SAS software v9.2 (SAS Institute, Cary, NC). HIV testing before delivery occurred among 3,438 women (73.9 %); African American and Hispanic women were more likely to be tested than white women [aOR 2.22, 95 % CI (1.6–3.1) and aOR 1.55, 95 % CI (1.1–2.2), respectively]. Among women without previous HIV testing, 138 (16.6 %) were tested after admission to labor and delivery. Policies to test women with undocumented HIV status in at delivery were present in 65 (36.3 %) hospitals. HIV testing after admission to L&D was more likely in hospitals with policies to test women with undocumented HIV status [aOR 5.91, 95 % CI (2.0–17.8)]. Overall, policies and screening practices for HIV were consistently less prevalent than those for hepatitis B. Many women are not being routinely screened for HIV before or at delivery. Women with unknown HIV status were more likely to be tested in L&D in hospitals with testing policies.
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Lindegren, M. L., Byers, R. H., Thomas, P., Davis, S. F., Caldwell, B., Rogers, M., et al. (1999). Trends in perinatal transmission of HIV/AIDS in the US. JAMA, 282, 531–538.
Centers for Disease Control and Prevention. (2011). Diagnoses of HIV infection and AIDS in the United States and Dependent Areas. HIV Surveillance Report, 23. http://www.cdc.gov/hiv/surveillance/resources/reports/2011report/index.htm.
Fleming, P. L., Lindegren, M. L., Byers, R. H., Hammett, T., Harris, N., Schulte, J., et al. (2002). Estimated number of perinatal HIV infections, U.S. 2000. International conference on AIDS 2002 Jul 7–12, Barcelona, Spain.
Whitmore, S. K., Zhang, X., Taylor, A. W., & Blair, J. M. (2011). Estimated Number of Infants Born to HIV-Infected Women in the United States and Five Dependent Areas, 2006. Journal of Acquired Immune Deficiency Syndromes, 57, 218–222.
Townsend, C. L., Cortina-Borja, M., Peckham, C. S., de Ruiter, A., & Lyall, H. (2008). Tookey, PA. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000–2006. AIDS, 22(8), 973–981.
Centers for Disease Control and Prevention. (1995). U.S. Public Health Service recommendations for human immunodeficiency virus counseling and voluntary testing for pregnant women. MMWR, 44(No. RR-7):1–15.
Institute of Medicine, National Research Council. (1999). Reducing the odds: Preventing perinatal transmission of HIV in the United States. Washington, DC: The National Academy Press.
American College of Obstetricians and Gynecologists. (2004). ACOG Committee Opinion No 304: Prenatal and perinatal human immunodeficiency virus testing: Expanded recommendations. ACOG Committee on Obstetric Practice. Obstetrics and Gynecology, 104(5 Pt 1), 1119–1124.
American Academy of Pediatrics, American College of Obstetricians, Gynecologists. (1999). Joint statement on human immunodeficiency virus screening. Pediatrics, 104, 128.
Centers for Disease Control and Prevention. (2006). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-related settings. MMWR, 55(RR-14), 1–17.
Mahajan, A. P., Stemple, L., Shapiro, M. F., King, J. B., & Cunningham, W. E. (2009). Consistency of state statutes with the Centers for Disease Control and Prevention HIV testing recommendations for health care settings. Annals of Internal Medicine, 150(4), 263–269.
Neff, S., & Goldschmidt, R. (2011). Centers for Disease Control and Prevention 2006 human immunodeficiency virus testing recommendations and state testing laws. JAMA, 305(17), 1767–1768.
Anderson, B. L., Carlson, R., Anderson, J., Hawks, D., & Schulkin, J. (2012). What factors influence obstetrician-gynecologists to follow recommended HIV screening and testing guidelines? J Womens Health, 21(7), 762–768.
Jamieson, D. J., Cohen, M. H., Maupin, R., Nesheim, S., Danner, S. P., Lampe, M. A., et al. (2007). Rapid human immunodeficiency virus-1 testing on labor and delivery in 17 US hospitals: The MIRIAD experience. American Journal of Obstetrics and Gynecology, 197(3 Suppl), S72–S82.
Centers for Disease Control and Prevention. (2011). Enhanced perinatal surveillance—15 areas, 2005–2008. HIV Surveillance Supplemental Report, 16(2). http://www.cdc.gov/hiv/topics/surveillance/resources/reports/. Published April 2011.
Anderson, J. E., & Sansom, S. (2006). HIV testing among U.S. women during prenatal care: Findings from the 2002 National Survey of Family Growth. Maternal and Child Health Journal, 10(5), 413–417.
Willis, B. C., Wortley, P., Wang, S. A., Jacques-Carroll, L., & Zhang, F. (2010). Gaps in hospital policies and practices to prevent perinatal transmission of hepatitis B virus. Pediatrics, 125(4), 704–711.
Schrag, S. A., Arnold, K. E., Mohle-Boetani, J. C., Lynfield, R., Zell, E. R., Stefonek, K., et al. (2003). Prenatal screening for infectious diseases and opportunities for prevention. Obstetrics and Gynecology, 102(4), 753–760.
Weisbord, J. S., Koumas, E. H., Toomey, K. E., Grayson, C., & Markowitz, L. E. (2001). Sexually transmitted diseases during pregnancy: Screening, diagnostic, and treatment practices among prenatal care providers in Georgia. Southern Medical Journal, 94(1), 47–53.
Centers for Disease Control and Prevention. (2006). Sexually transmitted diseases treatment guidelines. MMWR, 55(RR11), 1–94.
Anderson, T. A., & Wexler, D. L. (2003). States report hundreds of medical errors in perinatal hepatitis B prevention: Avoid tragic mistakes- vaccinate newborns against HBV in the hospital. Immunization Action Coalition. Available from: http://www.immunize.org/catg.d/p2062.pdf.
Taylor, A. W., Ruffo, N., Griffith, J., Kourtis, A. P., Clark, J., Lindsay, M., et al. (2007). The missing link: Documentation of recognized maternal human immunodeficiency virus infection in exposed infant birth records, 24 United States jurisdictions, 1999–2003. American Journal of Obstetrics and Gynecology, 197(3 Suppl), S132–S136.
Fernandez, M. I., Wilson, T. E., Ethier, K. A., Walter, E. B., Gay, C. L., & Moore, J. (2000). Acceptance of HIV testing during prenatal care. Perinatal Guidelines Evaluation Project. Public Health Reports, 115(5), 460–468.
Du, P., Camacho, F., Zurlo, J., & Lengerich, E. J. (2011). Human immunodeficiency virus testing behaviors among US adults: The roles of individual factors, legislative status, and public health resources. Sexually Transmitted Diseases, 38(9), 858–864.
Wing, C. (2009). Effects of written informed consent requirements on HIV testing rates: Evidence from a natural experiment. American Journal of Public Health, 99, 1087–1092.
Zetola, N. M., Grijalva, C. G., Gertler, S., Hare, C. B., Kaplan, B., Dowling, T., et al. (2008). Simplifying consent for HIV testing is associated with an increase in HIV testing, case detection in highest risk groups, San Francisco January 2003–June 2007. PLoS ONE, 3(7), e2591.
We extend great appreciation to all delivery hospitals and perinatal hepatitis B coordinators for participating in the survey and record review without which this data would not be available and Pascale Wortley, MD MPH (CDC National Center for Immunization and Respiratory Diseases, Immunization Services Division, and Respiratory Diseases, Immunization Services Division, Atlanta, GA). Health Research and Evaluation Branch and Immunization Services Division, CDC.
Conflict of interest
None of the authors have a conflict of interest.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Location of study: 50 United States, District of Columbia and Puerto Rico.
Data presented in part at the 2009 National HIV Prevention Conference, Centers for Disease Control and Prevention Atlanta, GA August 23–26, 2009. Presented on August 25, 2009.
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Fitz Harris, L.F., Taylor, A.W., Zhang, F. et al. Factors Associated with Human Immunodeficiency Virus Screening of Women During Pregnancy, Labor and Delivery, United States, 2005–2006. Matern Child Health J 18, 648–656 (2014). https://doi.org/10.1007/s10995-013-1289-7