title: Influence of an "opt-out" test strategy and patient factors on human immunodeficiency virus screening in pregnancy.
abstract: OBJECTIVE
  To estimate both human immunodeficiency virus (HIV) testing acceptance rates in pregnancy using an opt-out policy and patient characteristics influencing acceptance.
  
  
  METHODS
  At the first prenatal visit, HIV testing was offered using an opt-out approach. Reasons for refusing testing were explored. Demographic information was collected on all study subjects.
  
  
  RESULTS
  In the prospective portion of the study, 1,140 of 1,233 women (92.5%) accepted testing. Race was predictive of accepting HIV testing, with Asian women significantly less likely (odds ratio [OR] 0.4; 95% confidence interval [CI] 0.3-0.6; P<.001) and Hispanic women significantly more likely (OR 6.9; 95% CI 2.2-22.0; P=.001) to be tested. Although English as a first language, country of birth, and insurance status were not significantly associated with acceptance, women who were fluent in English were more likely to be tested (OR 2.0; 95% CI 1.2-3.3; P=.01). Our testing rates were significantly higher than the provincial average.
  
  
  CONCLUSIONS
  Using an opt-out strategy, HIV testing rates in our clinic were significantly higher than the provincial average. Rates were influenced by race and fluency in English.
authors.affiliation: Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. yudinm@smh.toronto.on.ca
authors.forename: Mark H
authors.initials: MH
authors.lastname: Yudin
authors.forename: Catherine
authors.initials: C
authors.lastname: Moravac
authors.forename: Rajiv R
authors.initials: RR
authors.lastname: Shah
mesh_terms: D015492:AIDS Serodiagnosis / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D044466:Asian People; D003657:Decision Making; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000208:ethnology; D006801:Humans; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D010358:Patient Participation; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D011296:Prenatal Diagnosis / Q000523:psychology*; D011446:Prospective Studies; D012189:Retrospective Studies