An Analysis of Perinatal HIV Testing and Screening Practices Documented for Women Delivering at an Urban Academic Medical Center

Background: Mother-to-child HIV transmission (MTCT) is greatly reduced with initial testing, re-test 3rd trimester and at delivery. Some metropolitan areas like Miami account for disproportionate MTCT in the United States (US). Per CDC guidelines, HIV testing in pregnancy follows “Opt-out testing": include with standard antenatal screening, unless patient “opts out”. Specifically, the CDC recommends: (a) HIV screening early as possible; and, (b) repeat testing in 3^rd trimester in high HIV prevalence areas and for women at risk of acquiring HIV; (c) women not tested in pregnancy or with undocumented HIV status are offered rapid screening on labor/delivery. We sought to quantify documented prenatal (PN) HIV screening in Miami for women delivered at a tertiary care academic medical center.

Methods: A sub-analysis was conducted on 753 delivered women with at least one documented PN visit in 1^st or 2^nd trimester, and one documented 3^rd trimester visit. Records with undocumented PN HIV testing were excluded. The cohort was derived from a retrospective review of 1003 deliveries from January and June, 2015. Race, ethnicity, education, and third trimester testing were analyzed, then stratified by PN clinic. Race and ethnicity were recoded hierarchically; race/ethnicity, education and clinic were collapsed into 3-level variables.

Results: We analyzed 753 cases. Majority were minorities (51% Hispanic, 27% Black, non-Hispanic), mean age of 30 years, high school attained (65%). Over half (56%) received care at or within the hospital's academically-affiliated clinic system, 27% elsewhere, and 16% transferred into the hospital's clinic system. Whereas an equal proportion receiving PN with the hospital’s clinic system had no documentation of 3^rd trimester screening (14.9% vs 14.6%), a significantly higher proportion (49.4%; p=0.000) receiving PN outside of the hospital clinic system were not re-tested 3^rd trimester.

Conclusion: The data indicate that 3^rd trimester HIV re-test, as recommended by the CDC, was not consistently offered prenatally in this cohort delivering in an HIV high risk region. A significantly higher proportion of women receiving PN outside of the hospital's clinic system were not retested 3^rd trimester. Additional education for PN providers of women in care in HIV high risk metropolitan regions could yield higher 3^rd trimester HIV re-test.