title: Clinical outcomes of routine opt-out antenatal human immunodeficiency virus screening: a systematic review.
abstract: OBJECTIVE
  To evaluate the clinical outcome of routine screening of human immunodeficiency virus in antenatal clinic settings.
  
  
  BACKGROUND
  Despite the growing advances in human immunodeficiency virus management, nearly 30% of the estimated 1·5 million seropositive pregnant women are undiagnosed. Routine opt-out testing is a strategy endorsed by the World Health Organization in to increase testing rates in clinical settings.
  
  
  METHODS
  A systematic review of relevant published literature.
  
  
  METHODS
  A comprehensive electronic search for relevant studies in Science Direct, MEDLINE, SCOPUS, CINAHL and PubMed was conducted with search terms (Box 2). Hand searches were also conducted for additional resources. There were no geographical restrictions. Searches were restricted to English language and studies conducted between 1998-2015; totaling 1097 were retrieved and carefully appraised for review. Eighteen studies were eligible for review: eight from Africa, five from the United States, three from Europe, one from Australia and one from Asia.
  
  
  RESULTS
  Fourteen studies reported increases in human immunodeficiency virus testing rate. Following the introduction of routine testing, human immunodeficiency virus testing rates increased from values ranging from 68-99·9% with median value of 88%. The comparison studies reported testing uptake of 22-93·5% with median value of 59%. Maternal human immunodeficiency virus case detection rates nearly doubled following adoption of routine testing at values of 99 and 45% during opt-in. Linkage to treatment and care for prevention of vertical transmission was reported on six studies, and results ranged between 12·9-77·2%.
  
  
  CONCLUSIONS
  The findings show that irrespective of human immunodeficiency virus epidemiological scenarios, routine testing gave more women opportunity to learn their human immunodeficiency virus status and take measures for prevention of mother-to-child transmission of human immunodeficiency virus. Future studies should focus on identifying strategies to improving linkages to treatment and care for prevention of vertical transmission.
  
  
  CONCLUSIONS
  Understanding the contributions of Routine opt-out testing in antenatal clinic would help practitioners adopt the novel testing model for more mothers to learn their human immunodeficiency virus status for prevention of mother-to-child transmission.
authors.affiliation: Nursing Department, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK.
authors.forename: Everistus
authors.initials: E
authors.lastname: Ibekwe
authors.affiliation: Nursing Department, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Haigh
authors.affiliation: Department of Research Institute for Health & Social Change, Faculty of Health, Rehabilitation and Psychology, Manchester Metropolitan University, Manchester, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Duncan
authors.affiliation: Department of Health Professions, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK.
authors.forename: Francis
authors.initials: F
authors.lastname: Fatoye
mesh_terms: D000328:Adult; D001294:Attitude to Health; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008403:Mass Screening / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D011296:Prenatal Diagnosis / Q000706:statistics & numerical data*; D011322:Primary Prevention
keywords: antenatal; counselling and testing; human immunodeficiency virus infection; prevention of vertical transmission; routine testing