Ante-natal HIV testing: An observational study of HIV test discussion in maternity care

There has been a vociferous call for ante-natal HIV testing but low uptake persists in the UK despite DOH guidelines. The reasons for this are complex, with many studies examining intention, offer and uptake of HIV test but few observing the process to understand the nature of HIV discussion with pregnant women. A field observational study was undertaken where researchers attended 154 ante-natal consultations. These were selected in rotation during ante-natal visits by women at four London hospital based ante-natal clinics. A standardized checklist was utilized to monitor information on HIV. A mean of 1.73 minutes was spent discussing HIV infection and testing during ante-natal consultations which lasted for a mean of 33.1 minutes. Risk factors for HIV were mentioned infrequently. When mentioned they concentrated on sexual behaviour which was raised in 11.7% of the consultations. Potential interventions to reduce vertical transmission were discussed with no more than one in five women and possible adverse implications of HIV testing with fewer than one in ten, the only exception being the implications of a positive diagnosis for the baby. Discussion of interventions was associated with HIV test uptake, but risk discussion was not. The short time spent on discussing HIV testing, combined with paucity of mention of information relevant to pregnancy are issues for concern and probably help to explain the level of uptake in the UK.