IAS: Routine HIV testing acceptable to most pregnant women in Zimbabwe

Routine HIV testing in antenatal services would be acceptable to the majority of women in Zimbabwe, according to a study presented to the Third International AIDS Society Conference on HIV Pathogenesis and Treatment in Rio de Janeiro on July 26^th. However, the investigators, from Zimbabwe and France, also found that a significant number of women would opt-out of voluntary HIV testing, mainly because they did not wish to know their HIV status or feared testing for HIV without their partner’s consent.

Low uptake of voluntary initiatives to prevent mother-to-baby transmission of HIV in Zimbabwe (where 25% of pregnant women are HIV-positive) led investigators to explore new ways of identifying HIV-positive pregnant women. One option they considered was routine antenatal HIV testing, requiring an individual to “opt out” rather than “opt in.”

Investigators wished to see how acceptable this approach would be and conducted a descriptive, cross-sectional study at six sites across Zimbabwe. A total of 520 women participated in the study and completed four questionnaires over a four month period.

In total, 285 women (55%) had been tested for HIV during pregnancy. The factors significantly associated with not testing for HIV at this time were unemployment of partner (p

Of the 235 women who did have an HIV test, 80% said that they would have accept routine HIV testing as part of antenatal services. The investigators identified being married (p = 0.03), secondary education or higher (p = 0.03) and receiving group education about mother-to-baby HIV transmission as being factors associated with acceptance of HIV testing.

However, 41 women (20%) said that they would still refuse an HIV test during pregnancy, even if it was offered on an opt out basis. The investigators found that the main reasons were that these women feared knowing their HIV status or required partner consent before testing.

The investigators conclude that the “introduction of routine HIV testing in antenatal care is acceptable to most women and would increase uptake of prevention of mother-to-child transmission services.” However, they caution that before this approach is adopted “issues regarding stigma, quality of post-testing counselling, and staffing will need to be considered.”