Examining the effectiveness of an opt-in approach to prenatal human immunodeficiency virus screening

Objective We sought to determine the prenatal human immunodeficiency virus (HIV) screening rate when using an opt-in policy and to find variables predictive of screening. Study Design This was a case-control study examining gravid women with a prenatal visit and a delivery at our hospital in 2005. Cases were defined as women who did not undergo HIV screening during the first or second prenatal visit. Our institution used an opt-in approach to HIV screening. Results Overall, 71% (291/412) of women underwent HIV screening at the first or second prenatal visit. Patient refusal was the most common reason for not being screened (15%; 62/412). Women who were ≤25 years old, were unmarried, and received care from maternal-fetal medicine attendings or family practitioners were more likely to undergo HIV screening. Conclusion With an opt-in approach, 29% of women were not screened for HIV during their early prenatal care. An opt-in policy also leads to screening rates that are provider dependent.