Fewer than half of physicians in northwest Ohio who treat women during pregnancy offer HIV testing to all their pregnant patients, according to a regional survey of obstetrician- gynecologists and primary care physicians.¹Among those physicians who routinely offer HIV testing as part of standard prenatal testing, a greater proportion of obstetrician-gynecologists than of family practitioners offer universal HIV testing (90% vs. 53%), whereas a greater proportion of internists (95%) than of family practitioners (78%) or obstetrician-gynecologists (86%) believe that HIV testing should be part of standard prenatal testing without pretest counseling or informed consent. In multivariate analysis, specializing in obstetrics and gynecology and having more than 60% of patients who accept HIV testing were significantly associated with physicians' offering HIV testing to all pregnant patients.

Using a database maintained by the Medical College of Ohio Physician Referral Service, researchers selected all physicians listed in northwest Ohio who specialized in obstetrics and gynecology, family medicine, internal medicine or other primary care fields. Between December 2000 and March 2001, selected physicians were sent a 20-question survey that asked about their demographic characteristics, practice demographics, and attitudes and practices regarding HIV testing in pregnancy. Physicians returned the surveys using a self-addressed, stamped envelope, and researchers analyzed the data using chi-square tests and multivariate logistic regression.

Overall, 1,116 surveys were mailed. Of the 261 physicians who returned an at least partially completed survey and provided care in any capacity to pregnant women, slightly more than half were aged 30-50, 60% saw 50 or fewer pregnant women per year, and the same proportion had their practices located primarily in rural or suburban areas. Only 16% reported predominantly seeing patients using Medicaid, and 5% saw mainly Hispanic or black patients. Sixteen percent of physicians had seen at least one pregnant woman with HIV in their practice, and 8% had ever diagnosed HIV infection in a woman during prenatal testing.

Forty-two percent of physicians reported that they offer an HIV test as part of their standard prenatal testing; 16% of physicians offered HIV testing to a quarter or fewer of their pregnant patients. Reasons cited for not routinely testing for HIV were perceived low incidence of HIV in the practice (17%), lack of patient acceptance (4%), difficulty with paperwork or counseling for testing (3% each), and lack of office staff or time (2%). Among those physicians who routinely offered HIV testing as part of prenatal testing, a greater proportion of obstetrician-gynecologists than of family practitioners said that they offer HIV testing to all of their pregnant patients (90% vs. 53%); a greater proportion of internists (95%) than of family practitioners (78%) or obstetrician-gynecologists (86%) believed that HIV testing should be part of standard prenatal testing without pretest counseling or informed consent.

When asked about their attitudes toward HIV testing during pregnancy, 54% of physicians believed that it should be a routine part of care, whereas 7% (mainly family medicine physicians older than 40 practicing in rural areas) felt that it was not necessary for most women. One-third believed that including HIV testing in standard prenatal care would increase their ability to routinely test for HIV, and slightly more than one-third (37%) felt that HIV testing in their practice would increase if they had brochures to aid pretest counseling. Forty-two percent of physicians agreed with the statement that women infected with HIV should not have children, whereas 3% strongly disagreed.

In chi-square analysis, several factors were significantly associated with physicians' offering HIV testing to all pregnant patients: specializing in obstetrics and gynecology; seeing 100 or more pregnant patients per year; being younger than 50; seeing primarily patients who use Medicaid; having more than 60% of patients accept HIV testing; having seen at least one pregnant patient with HIV; having made at least one HIV diagnosis through routine prenatal testing; and having a patient population that was at least 70% black. However, only specializing in obstetrics and gynecology and having more than 60% of patients accept HIV testing remained significant in multivariate analysis.

The researchers comment that prenatal HIV testing is the first step in preventing mother-to-child transmission and provides an important "prevention education opportunity." However, as access to obstetrician-gynecologists-- the specialists who are the most likely to offer prenatal HIV testing to all their pregnant patients--may be limited in rural areas such as northwest Ohio, the researchers suggest that "nonobstetricians and primary care physicians also include universal HIV testing for pregnant women."--J. Rosenberg

REFERENCE

1. Duggan J et al., Survey of physician attitudes toward HIV testing in pregnant women in Ohio, AIDS Patient Care and STDs, 2003, 17(3):121-127.