Abstract
Objective The Illinois Perinatal HIV Prevention Act was passed to ensure universal HIV testing
once during pregnancy and was extended in 2018 to add third trimester repeat HIV screening.
The objectives of this analysis were to describe uptake of, and patient factors associated
with, third trimester repeat HIV testing at a high-volume birthing center.
Study Design This is a retrospective cohort study of people who delivered at a single tertiary
care hospital in Illinois during 2018. Women who delivered before 27 weeks, had an
intrauterine fetal demise, a known diagnosis of HIV, or no HIV test during pregnancy
were excluded. Repeat testing was defined as an HIV test at or after 27 weeks' gestation
after an earlier negative HIV test during the same pregnancy. The primary outcome
was the proportion of people who received repeat testing prior to delivery. Bivariable
analyses were performed to identify patient characteristics associated with documentation
of repeat HIV testing.
Results Of 12,053 people eligible for inclusion, 3.4% (n = 414) presented without a documented third trimester repeat HIV test. The proportion
of people with repeat testing improved from 80 to >99% in the first year. Patient
factors were largely not associated with testing performance although multiparous
people were more likely to have documented repeat testing.
Conclusion Rapid implementation of third trimester repeat HIV testing was achieved without disparity.
Patient factors were largely not associated with testing performance which reinforces
the goal of a universal screen to test all people equitably and effectively without
bias.
Key Points
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Little is known about adherence to repeat third trimester HIV testing in pregnancy.
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Universal third trimester HIV screening was implemented with high uptake and without
disparity.
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Protocolization of repeat HIV testing in pregnancy may reduce bias compared to risk
based-screening.
Keywords
health care disparities - maternal health - public health - implementation science
