# Presentation: 848643

## Increasing Universal Offering of Voluntary Counseling and HIV Testing (VCT) and Test Acceptance During Prenatal Care in California

- Stanford University, 2002

## Needs Assessment 

- Identified gaps in VCT services in four CA counties in 2000-01 through:
- Client surveys and interviews (n=1363),
- Provider questionnaires (n=135),
- Special population focus groups, and
- A review of available relevant data.

- Stanford University, 2002

## Summary Findings

- Although CA law mandates offering VCT to all women in prenatal care (PNC), only 47.4% of women reported receiving counseling and 74.3% of women reported being offered an HIV test.
- However, 85.1% of providers report offering counseling and 93.2% report offering HIV testing  to >90% of their prenatal clientele.** **

- Stanford University, 2002

## Prenatal Care Access/Utilization

- The primary barrier to VCT is not receiving prenatal care.
- In CA, women most at risk of having no prenatal care are under 24, are Latina, and have less than a high school education.

- Stanford University, 2002

## Sociodemographic Barriers to Counseling

- Most likely to be counseled:
- Black,
- Under 25,
- Lived in the U.S. ten years or more,
- Private insurance.

- Least likely to be counseled:
- Asian/PI,
- Over 25,
- Lived in the U.S. one year or less.

- Stanford University, 2002

## Sociodemographic Barriers to HIV Test Offer

- Most likely to be offered a test:
- Black and White women,
- Private/HMO health coverage,
- Lived in the U.S. longer than 10 years.

- Least likely be offered a test:
- Asian/PI
- 35+ years old.

- Stanford University, 2002

## Barriers to Test Acceptance

- 1.    Test acceptance rates based on amount of time living in the U.S.:
- Less than one year: 93.8%
- More than ten years: 90.7%
- Between six and ten years: 87.7%
- Between one and five years:	83.6%

- Stanford University, 2002

## Barriers to Test Acceptance

- 2.     Acceptance rates by race/ethnicity:
- Mixed/Other: 95.4%
- Black: 92.2%
- Hispanic: 89.5%
- White: 88.0%
- Asian/ PI: 84.9%
- 3.    Acceptance rates by insurance status:
- Private insurance: 90.4%
- Medi-Cal: 90.3%
- All other: 85.5%

- Stanford University, 2002

## Reasons Test Was Accepted

- For my health and the health of my baby (92.1%).
- Because my doctor or nurse told me I should (68.1%).

- Didn’t feel like I had a choice (22.1%).
- Other: to be safe/sure, previous high-risk behavior, partners risk behavior.

- Stanford University, 2002

## Reasons Test Was Declined

- • I already had a test (43.7%).
- I didn’t think I could be HIV infected (33.3%).
- Not comfortable with how the doctor/ nurse asked me to take the test (16.1%)
- I didn’t want to know the result because I am afraid (10.6%).
- Other: thought it was done normally, afraid of being charged extra.

- Stanford University, 2002

## Women’s Input: How Can Women Be Encouraged to Test?

- It is better if they just tell me to take the test.
- It is easiest to just get a form to sign saying either yes or no.
- It is best if they just do the blood work and then send me the results.

- Stanford University, 2002

## Women’s Input: What is the Best Way to Offer an HIV test? 

- Give me all the explanations of things I could do or couldn’t do.
- Make sure women understand that they can help their baby’s health.
- Less formalized, clinical counseling.
- More support both before and after test.

- Stanford University, 2002

## Interventions to Increase VCT

- Provider Training
- Case Management

- Social Marketing
- Community Outreach

- Stanford University, 2002

## Provider Training		

- • Clarification of legal requirement to offer VCT to _every_ patient.
- Update on treatment options.
- Information from the needs assessment.
- Effective counseling materials.

- Stanford University, 2002

## Consumer Education

**Community Outreach and Social Marketing:** Increase knowledge about pregnancy and HIV among pregnant women, their partners, and the community as a whole.

- Stanford University, 2002

## Case Management

- Can help a woman make informed decisions about testing and treatment acceptance.
- Can provide extra support both during and after testing process.
- Can help insure woman receives full spectrum of needed services.

- Stanford University, 2002

## Brief Summary

- Providers must offer VCT to all clients either by providing VCT themselves or by referring clients to a counseling and/or testing specialist.
- Women and their partners need to learn about HIV and pregnancy and receive support around these issues.

- Providers and others offering VCT need access to quality materials to help with the counseling process and should understand the affect their attitudes may have on client testing choice.

- In order to increase VCT and test acceptance rates in CA:

- Stanford University, 2002

## Acknowledgments

- California Department of Health Services, Office of AIDS
- CDC
- Alameda County
- Sacramento County

- San Diego County
- San Joaquin County
- Stanford University

- Stanford University, 2002