Some OBs unclear on HIV testing requirements

Some OBs unclear on HIV testing requirements
NEW YORK (Reuters Health) - Although virtually allobstetrician-gynecologists recommend HIV testing to all theirpregnant patients, some are unaware of their state requirementsfor recommending such testing, according to a report in theObstetrics & Gynecology.
Several organizations, including the Centers for DiseaseControl and Prevention, have recommended that all pregnantwomen be screened for HIV, using an opt-out approach, as partof routine prenatal care, the authors explain.
With the opt-out testing strategy, the woman tested unlessshe explicitly refuses. She is provided information on HIV andtold that a test will be performed as part of a battery ofstandard tests. She is also informed that she has the right todecline testing.
The opt-in testing approach requires an explicit requestfor an HIV test. After a woman has received HIV information,she is asked if she wants an HIV test. She is tested only ifshe specifically agrees and, in most cases, signs and aninformed consent form.
Dr. Jay Schulkin and colleagues from the American Collegeof Obstetricians and Gynecologists, Washington, DC surveyedobstetrician-gynecologists regarding HIV knowledge. A total of1,032 questionnaires were sent out and 582 were returned.
All but 3 percent of obstetrician-gynecologists reportedthat they recommend HIV testing to all of their pregnantpatients, the authors report, though nearly three quarters ofobstetrician-gynecologists considered 5 percent or fewer oftheir pregnant patients to be at high risk for HIV infection.
Obstetrician-gynecologists were fairly evenly divided as towhether they tested their pregnant patients for HIV using theopt-in approach (52 percent) or the opt-out approach (48percent).
Just over half the obstetrician-gynecologists (57 percent)reported using the HIV testing approach required in theirstates, the researchers note, while 43 percent reported usingan approach not consistent with their state's regulation.
Nearly one third of obstetrician-gynecologists said theydid not know if their state required HIV testing duringpregnancy.
Most obstetrician-gynecologists responding to the surveyreported that they provide pretest counseling before HIVtesting (73.7 percent) and post-test counseling (84.6 percent).
"The results of this study suggest thatobstetrician-gynecologists may benefit from additionalinformation that could improve their knowledge and practiceregarding HIV screening," the investigators write.
"Although most respondents report being at least moderatelyknowledgeable about HIV during pregnancy and reportrecommending HIV testing to all pregnant patients, they mayneed to be more aggressive in following up with patients whodecline HIV testing."
SOURCE: Obstetrics & Gynecology, November 2007