Adherence to policy guidelines—a review of HIV ante-natal screening policies in the UK and Eire

Adherence in HIV care has generated much debate in relation to treatment regimens. However the concept of adherence is not confined to patient behaviour, and adherence to policy and procedures may also contribute to the effective implementation of preventive strategies. This study reviews adherence of Obstetric Units in the UK and Eire ( n = 256, 89% response rate) with regard to implementation of ante-natal HIV testing policies. A postal questionnaire was constructed to monitor policy and practice in all obstetric units in the UK and Eire. Ten per cent of units operated universal screening policies, 37% selective and the majority (54%) on request only. Universal offer of ante-natal testing was concentrated in London Units. Those utilizing selective policies rarely invoked all the CDC risk criteria as a basis for selection. Consent to test was verbal in 53%, written in 20% and unrecorded in the remainder. The provision of information varied and despite widespread midwifery training on HIV pre- and post- test counselling, doctors played a key role in result provision. The burden of HIV testing was rarely funded, with only 8% of units having a specifically funded post. Having a funded post was significantly associated with HIV test uptake ( f = 7.99, p = 0.0001) as was training of medical staff in HIV testing provision ( t = 4.1 , p = 0.0001). Auditing/evaluation was infrequent. As the Department of Health provides specific guidance on the offer of ante-natal HIV testing, this audit shows that in order for such policies to be implemented ongoing audit and training as well as funding may facilitate the successful implementation of such policy. Adherence is a challenge generally.