Percentage and determinants of missed HIV testing in pregnancy: a survey of women delivering in the Lazio region, Italy

Abstract

HIV testing is recommended as part of routine preconception and prenatal care but some cases of vertical transmission still occur because of missed HIV testing in pregnancy. We estimated the percentage of women missing HIV testing before delivery, and we evaluated factors related with it. An anonymous survey was distributed to women giving birth during a two-week period in the maternity units of hospitals in the Lazio region of Italy in 2011. Among the 1568 women who filled out the questionnaire, only 33.6% had an HIV test prior to conception, while 88.2% were tested during pregnancy; main reasons reported for missed testing were: not requested by the gynaecologist (57.0%), performed previously (20.7%), requested by the gynaecologist but not done (13.3%) and structural/organisational barriers (4.4%). The percentage of women who missed the HIV test as part of preconception care or during pregnancy was 9.1% (95% confidence interval, CI: 7.7–10.6). Multivariate analysis showed that those with missed test were younger (p = 0.05), of lower education level (p < 0.01), with a lower HIV-knowledge score (p < 0.01) and with fewer visits during pregnancy (p < 0.01). Around 10% of delivering women were not tested for HIV during pregnancy or as part of preconception care. Absence of a specific request by the gynaecologist was the most frequent reason given. The association of missed HIV testing with poor sociocultural level and limited maternal HIV knowledge emphasise the importance of promoting HIV information among women and prenatal care providers. Strategies to increase routine testing may include the adoption of an opt-out approach. Finally, availability of rapid HIV testing in the delivery room should be encouraged.

Keywords:

• HIV testing
• pregnancy
• delivery
• Italy
• antenatal care

Acknowledgements

The study was partly supported by a grant of the Italian Ministry of Health (project 102, ricerca finalizzata 2007) entitled “Delayed diagnosis and presentation to care for tuberculosis and HIV infection: analysis of determinants and evaluation of strategies to improve timely access to care”.

The study was promoted by the Istituto Superiore di Sanità (i.e., the Italian National Institute of Health), and the following Italian scientific societies: Società Italiana di Ginecologia e Ostetricia (SIGO), Collegio Provinciale delle Ostetriche di Roma, Società Italiana di Infettivologia Pediatrica (SITIP) and Società italiana di Malattie Infettive e Tropicali (SIMIT).

Other contributors to the study are as follows. Members of the multidisciplinary team: Bernardi Stefania (Ospedale Pediatrico Bambino Gesù – IRCCS, Rome), Carboni Angela (Laziosanità-Agenzia di Sanità Pubblica della Regione Lazio, Roma), Floridia Marco (Istituto Superiore di Sanità, Roma), Pellegrini Maria Grazia (Ospedale San Giovanni Calibita – Fatebenefratelli, Roma), Pezzotti Patrizio (Laziosanità-Agenzia di Sanità Pubblica della Regione Lazio, Roma), Puro Vincenzo (Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani – IRCCS, Roma), Tamburrini Enrica (Policlinico Universitario Agostino Gemelli, Roma), Valle Sabrina (Laziosanità – Agenzia di Sanità Pubblica della Regione Lazio, Roma), Vittori Giorgio (Ospedale San Carlo di Nancy, Roma).

Participating midwives (with their hospitals, cities) collecting data: Colantoni Ileana (Casa di Cura Fabia Mater, Roma); Cimino Lucia, Franca Monti (Policlinico Gemelli, Roma); Baldacchino Calogera (Casa di Cura Santa Famiglia, Roma); Pistilli Sabrina (Ospedale Santa Maria Goretti, Latina); Caramia Maria Lucia (Aurelia Hospital, Roma); Donnini Gina (Ospedale Coniugi Bernardini Palestrina); Malorgio Roccuccia (Ospedale Cristo Re, Roma); Sevi Laila (Ospedale Generale Madre Giuseppina Vannini, Roma); Cucchiarelli Paola, Trombetti Emanuela (Ospedale Civile di Velletri, Velletri); Coletta Elisabetta (Ospedale Leopoldo Parodi Delfino, Colleferro); Griguoli Maria Cristina (Policlinico Casilino, Roma); Lops Francesca (Ospedale San Giovanni Calibita – Fatebenefratelli, Roma); Favale Daniela (Ospedale Generale Provinciale San Giuseppe, Marino); Tagliani Mirella (Ospedale San Paolo, Civitavecchia); Coppola Paola, De Luca Giuliana (Ospedale Santo Spirito, Roma); Frasi Assunta (Ospedale Fabrizio Spaziani, Frosinone); Quadrini Finisia (Ospedale Santissima Trinità, Sora); Ferrari Domenica (Ospedale Santissimo Gonfalone, Monterotondo); De Marco Annarita (Ospedale San Benedetto, Alatri); Bibbiani Stefania, Ambrosini Antonella (Ospedale di Belcolle Viterbo); Bertelli Emanuela, Ravazzi Cristina, Bucci Rita, Anzalone Gherardi Lucia (Azienda Ospedaliera San Camillo, Roma); Antolini Sabrina, Leonetti Teresa (Azienda Ospedaliera San Giovanni Addolorata, Roma); Di Lucia Liliana (Ospedale Santa Scolastica, Cassino); Noce Anna Rita (Ospedale Civile di Formia, Formia); Percoco Assunta (Ospedale San Giovanni di Dio, Fondi); Arnaldi Maria Grazia, Ciaglia Annamaria (Ospedale Civile Ercole De Santis, Genzano); Pelo Maria Cristina (Ospedale Civile di Tarquinia, Tarquinia); Spagnolo Anna Romilda (Ospedale San Giovanni Evangelista, Tivoli); Del Frate Carla (Casa di Cura Città di Aprilia, Aprilia); Caronti Annalisa (Ospedale Generale Provinciale, Anzio); Scaffidi Antonella (Azienda Ospedaliera San Filippo Neri, Roma); Gentile Rita (Ospedale Giovanni Battista Grassi, Roma); Luciani Patrizia (Ospedale S. Pietro Fatebenefratelli, Roma); Giuffré Franco Donato (Policlinico Umberto I, Roma); Giorgi Elisabetta (Ospedale Sandro Pertini, Roma); Campanelli Bernardina (Ospedale San Camillo de Lellis, Rieti); Di Pasquali Rosa (Ospedale Arnaldo Angelucci, Subiaco). Members of the Collegio Provinciale delle Ostetriche di Roma: Pellegrini Maria Grazia, Rinaldi Iolanda, Oliva Carla, Vecchione Celeste, Proietti Patrizia, Antolini Sabrina.