News Release

Universal antenatal HIV screening needed in areas of high prevalence

Peer-Reviewed Publication

BMJ

(Universal HIV screening of pregnant women in England: cost effectiveness analysis)

(Antenatal HIV testing: assessment of a routine voluntary approach)

Universal voluntary antenatal HIV screening should be implemented in the London area, argue researchers in this week's BMJ. Dr Eddy Beck from Imperial College, London, UK and Dr Maarten Postma from the National Institute of Public Health and the Environment in the Netherlands, along with their colleagues also believe that serious consideration of such a policy should be given for other areas in England, depending on prevalence and screening costs

The lifetime costs of care for a child infected with HIV have been estimated at 178,300. However, screening pregnant women for HIV can avert this cost and lead to gains in life years for both mothers and children, say Postma et al. In high prevalence areas, screening pregnant women for HIV is estimated to be a cost effective intervention with a net cost of less than 4,000 for each life year gained.

In a separate paper, also in this week's BMJ, Dr Wendy Simpson from the University of Edinburgh along with colleagues from Glasgow investigated the effect on uptake of antenatal HIV testing (which is currently low in Britain) if testing was routine unless a woman declined - ie opt-out testing.

Of the 924 pregnant women studied, 816 (88.3 per cent) had an HIV test and when asked "Do you think the HIV test should be a routine test like all the other blood tests during pregnancy?", most women (87.7 per cent) said yes.

Simpson et al report that the uptake of the HIV test in this study was more than double the rate of uptake in one of their previous studies, where women were required to opt-in to the test (88 per cent as opposed to 35 per cent) and that the opt-out approach was not time consuming, required no extra staff and was positively endorsed by most women.

However, the authors say that such an approach will not necessarily achieve a similar outcome in London, where there are more complex issues of language and different cultures. But, they conclude, so long as safeguards are in place to ensure that women can make a fully informed choice, their routine voluntary approach is in keeping with recent guidelines.

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Contact for Universal HIV Screening:

Dr Eddy Beck, Senior Lecturer, Department of Epidemiology and Public Health, Imperial College School of Medicine, London e.beck@ic.ac.uk

Contact for Antenatal HIV Screening:

Dr Wendy Simpson, 22 Lumsden Park, Cupar, Fife KY15 5YL wendy@lumsdenpark.freeserve.co.uk



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