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Acknowledgments

Uptake of HIV testing among pregnant women in Ontario: Results from the HIV seroprevalence study to December 2000. Robert S. Remis, Carol Major, Margaret Fearon, Evelyn Wallace, Peggy Millson, Liviana Calzavara, Elisabeth Rea, Susan King, Marion Vermeulen and Elaine Whittingham

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Acknowledgments

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  1. Uptake of HIV testing among pregnant women in Ontario: Results from the HIV seroprevalence study to December 2000 Robert S. Remis, Carol Major, Margaret Fearon, Evelyn Wallace, Peggy Millson, Liviana Calzavara, Elisabeth Rea, Susan King, Marion Vermeulen and Elaine Whittingham Department of Public Health Sciences, University of Toronto Laboratories Branch, Public Health Branch, Ontario Ministry of Health and Long Term-Care Toronto Public Health Hospital for Sick Children, Toronto Canadian Association of HIV/AIDS ResearchTenth Annual Scientific ConferenceToronto, Ontario May 31-June 2, 2001

  2. Acknowledgments • Central Public Health Laboratory, Ontario Ministry of Health and Long-Term Care • Keyi Wu, programming • Mark Fisher, systems consulting and custom download • Carol Swantee, program support • Prenatal Screening Evaluation Committee • Frank McGee, coordinator • Janis Tripp, consultant • Funding • AIDS Bureau, Ontario Ministry of Health • Bureau of HIV/AIDS, STD & TB, Health Canada

  3. Background • 1989-91: Ontario HIV seroprevalence study (Coates et al), 0.23 / 1,000 • February 1994: ACTG 076 showed 67% decrease in mother-infant HIV transmission • 1997: Modeled HIV prevalence, 0.70/1,000and estimated uptake of prenatal HIV testing 1994-96, 20–25%

  4. Ontario screening program • Spring 1995: Advisory to physicians to consider HIV testing of pregnant women • August 1997: Committee formed to plan program • December 1998: Minister announced program to offer HIV testing to all pregnant women • January 1999: Promotional materials and requisitions sent to physicians

  5. Study objectives • Quantify and characterize HIV prevalence among women in Ontario, and • Evaluate the Ontario universal HIV screening program

  6. Data management • Data extracted from Labyrinth (prenatal and HIV diagnostic) • Study period Jan 3, 1999 to Dec 30, 2000 • Specimens from prenatal database included only if no previous specimen in the previous 6 months • Records for which HIV testing not prescribed on requisition matched to records in HIV diagnostic database • Matching allowed for different spelling and structure of name (double-barrelled first and last names) and reversal of month/day in birth date

  7. Data analysis • Number of women tested at prenatal visit included: • Women for whom test ordered on prenatal requisition, and • Women tested though diagnostic service on same day as prenatal specimen • Analysis in SAS of: • Trends over time in proportion tested • Testing rates by health region and age group • HIV-positive women: number and rates by type of test, region and quarter

  8. Number of prenatal specimens by health region, January 1999 to December 2000

  9. Number of prenatal specimens and number testing for HIV by quarter

  10. HIV testing among women who submitted a prenatal specimen

  11. HIV testing among women who submitted a prenatal specimen

  12. HIV testing among women who submitted a prenatal specimen

  13. Proportion of pregnant women testing for HIV by health region, last quarter 2000

  14. Number of PHUs in each region by proportion of HIV testing, last quarter 2000

  15. Number of HIV-positive women

  16. HIV-positivity rates by time of diagnosis and quarter

  17. HIV-positivity rates (per 1,000) by time of diagnosis and period

  18. HIV-positivity rates (per 1,000) by health region and period for diagnoses at prenatal screening

  19. Interpretation • Actual uptake of HIV testing may be higher due to false non-matches (e.g. anonymous HIV testing) • Study does not indicate why uptake is less than ideal (qualitative research of pregnant women and physician survey are under way) • Study does not indicate number of HIV-infected women undiagnosed • Unlinked component of HIV seroprevalence study among women not HIV tested is critical • This component has been delayed for almost two years by Ministry

  20. Conclusions • Critical to capture data from HIV diagnostic database as well as from prenatal database • HIV testing increased from 38% to 49% from January to May 1999, with modest increase since • Important regional differences in HIV test uptake • Over 2 years, 47 women identified as HIV-positive, 13 previously diagnosed, 32 newly diagnosed • Data suggests more high risk pregnant women are being offered and accepting HIV testing

  21. Conclusions • According to model (not presented) • Birth rate among diagnosed HIV-infected women is very low • ~50% of HIV-infected women undiagnosed at conception remain undiagnosed • Approximately 6–8 preventable mother-infant transmissions occur annually

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