Improving the Uptake of Human Immunodeficiency Virus (HIV) Antenatal Screening in a Primary Healthcare Setting

Abstract

Introduction: It has been well established that proper treatment and management of human immunodeficiency virus (HIV)-infected mothers can decrease virus transmission to their fetuses. HIV screening of antenatal mothers attending government polyclinics was offered from 1998 at a subsidised cost of $5 and given on a voluntary basis. The polyclinics provide antenatal care to approximately 12% of pregnant mothers in Singapore who belong mainly to the lower socio-economic group. The uptake of the HIV screening by these mothers has been poor. Materials and Methods: A one-month study was first undertaken in 1999 to determine the reasons for the poor uptake and to propose recommendations for improving the uptake. A second one-month study was undertaken in 2001 to evaluate the effect of the new strategies after implementation. Findings: This first study showed that refusal for the test was mainly due to poor perception of risk among the mothers. The HIV screening test was incorporated into an antenatal screening package and consent was obtained for this package. This was implemented on an opt-out basis. The second study done after implementation showed that the uptake of the HIV screening improved from 45% to 99%. Conclusion: The incorporation of the antenatal HIV screening into an antenatal screening package, and implementing this on an opt-out basis, improves uptake to almost a universal level.