HIV testing on women seeking termination of pregnancy (TOP): population characteristics and attitude to HIV testing

Background:
BHIVA Guidelines (2008) on HIV testing suggest there should be universal opt out testing for HIV for all women attending TOP clinics in the UK [1]. As yet this is not widespread and little data exists on its acceptability and uptake. It is known however from anonymous seroprevalence studies that women attending London TOP services were a higher risk population for HIV infection than women attending antenatal services (0.8% compared to 0.4%) [2].
Methods:
Funding was obtained from Gilead Sciences Ltd to offer opt out HIV testing to all women attending the TOP service at the Royal Free Hospital in London. Clinical TOP staff were keen to offer HIV testing along with routine chlamydia screening .Protocols and pathways were developed and training conducted for TOP staff. Routine opt out HIV testing was commenced and patients were offered a brief discussion pre testing and an information sheet was given to all women on arrival in clinic. The first 100 women offered testing were asked to complete a semi structured questionnaire to identify any issues in establishing this service. Basic data and reason for refusing an HIV test were also obtained for the first 202 women offered testing from the clinical database.
Results:
Of the first 202 women offered HIV testing, 170 (84.2%) accepted. The commonest reason for declining testing was having a negative test in the past 12 months (n=8), already being HIV positive (n=2) and not feeling they were at risk (n=2). Only 2 refused because they were unhappy about testing that day. 72 women completed the brief questionnaire about HIV testing in the TOP service. Age range was 16–43 years with a mean age of 28 years. Fifty seven percent (41/72) were born overseas. Seventy four percent (53/72) had accepted HIV testing that day, 80.6% in those born in the UK and 68.3% in those born overseas. Fifty percent had never had an HIV test before. Only 2% thought it was unacceptable to offer HIV testing in the TOP service.
Conclusions:
HIV testing is acceptable in the TOP setting. This data suggest that patients are frequently non UK born and have not previously tested for HIV making it a worthwhile area to offer HIV testing. Uptake was high and offering testing was easily incorporated into routine workloads for clinic staff.