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AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
Voluntary HIV testing in the antenatal clinic: Differing uptake rates for individual counselling midwives a
b
a
J. Meadows , S. Jenkinson , J. Catalan & B. Gazzard
c
a
Academic Department of Psychiatry , Charing Cross and Westminster Medical School , b
Department of Obstetrics & Gynaecology , West London Hospital ,
c
Westminster Hospital , Published online: 25 Sep 2007.
To cite this article: J. Meadows , S. Jenkinson , J. Catalan & B. Gazzard (1990) Voluntary HIV testing in the antenatal clinic: Differing uptake rates for individual counselling midwives, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 2:3, 229-233, DOI: 10.1080/09540129008257735 To link to this article: http://dx.doi.org/10.1080/09540129008257735
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
AIDS CARE, VOL. 2, NO. 3,1990
229
Downloaded by [JAMES COOK UNIVERSITY] at 09:04 17 March 2015
Voluntary HIV testing in the antenatal clinic: differing uptake rates for individual counselling midwives J. MEADOWS', S. JENKINSON~,J. CATALAN' & B.
GAZZARD3
'Academic Department of Psychiatry, Charing Cross and Westminster Medical School, ZDepartmentof Obstehics 13Gynaecology, West London Hospital and Westminster Hospital
Abstract This study looked at 12 midwives in the Riverside Health Authority who counselled parturient women about having the HIV antibody test. Results showed that the uptake rate of the test varied considerably across midwives (82% to 3%). Uptake rate varied, to some extenr, by ethnic group of the midimye; Afro-Caribbeans hawing 36% uptake, others 11%. However, the wide variatabn wizhin these groups suggests that ethnicity alone does not explain the di&ence in uptake rate. Factors which could be associated with uptake rate are the individual characteristics of both the midwije and of the antenatal clinic anender, such as age, ethnicity, knowledge of and am'tudes to HIV and antibody testing, as well as the counselling approach of the individual mideoije. Introduction The necessity for identifying women positive for HIV antibodies during pregnancy by voluntary testing remains an area of controversy. Results from the RCOG study of HIV infection in pregnancy in the United Kingdom show that in 46% of women who are HIV positive, the infection was identified by antenatal testing, Davison et al. (1989). It is unlikely that they would have been tested had they not become pregnant. However, as with any other medical test, health care professionals should question the value of testing for HIV. First, will future treatment or behaviour be affected? If not, then testing may be of little value. Secondly, what is the sensitivity and specificity of the test? If there is an unacceptably high proportion of false positive results yielded by the test, does this not throw its predictive value into question? In antenatal clinics in the United Kingdom, these are some of the considerations for the midwife counselling a woman about having an HIV antibody test. The midwife's primary responsibility is to ensure that the woman is aware of the possible advantages and disadvantages of HIV antibody testing. The midwife must point out that knowledge of HIV serologic status enables a woman to make an informed decision about her pregnancy and allows for appropriate care for herself and her child. It also allows for a change in sexual behaviour to prevent transmission of Address for correspondence: Jean Meadows, Prince of W d a Unit, Westminster Hospital, Dean Ryle Street, London SWl.
Downloaded by [JAMES COOK UNIVERSITY] at 09:04 17 March 2015
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J. MWDOWS ET AL.
infection to partners in the future. It should be noted, however, that no relationship has been found between knowledge of serologic status and behaviour change in other populations such as gay men and intravenous drug users (Institute of Medicine, 1988). Current knowledge about the effect of HIV infection on pregnancy and of pregnancy on the course of HIV disease, vertical transmission rates, etc. should be offered in the decision making process. Is identification of HIV infection therefore critical for medical, ethical or statutory reasons? (Minkoff & Landesman, 1988). Consideration should be given to the possibility of economic loss as a result of testing when, for example, insurance premiums are increased. Also there is a possibility of false reassurance by a negative result. This aspect, the ‘certificate of health effect’ (Tymstra & Bieleman, 1987), describes individual’s inclination to regard a negative result as justification for their risky behaviour and thereby as a denial of a need for change. Other negative psychological effects should be considered such as the encouraging of a sense of invulnerability which makes individuals less likely to return for further testing (Marteau, 1989). In the Riverside Health Authority, in 1987, a policy began of offering HIV antibody testing to all clients of antenatal clinics at St Stephens and Westminster Hospitals. The uptake rate for that year was 74% (Howard er al., 1989). During 1989, St Stephens and Westminster merged with the West London Hospital resulting in a greatly reduced uptake of 17% (Jenkinson & Meadows, 1990). This study reports on the differences in uptake rate according to the counselling midwife. It is part of a series of investigations into factors associated with decisions about HIV testing in antenatal clinic attenders and the psychological effects of the procedure. This work is being carried out by a research team in the Department of Psychiatry, Charing Cross Hospital and the Kobler Centre.
Patients and methods Over a 12 month period ending February 1990, a total of 788 women were booked for intrapartum care in the Riverside Health Authority. These women came in the main from Riverside West: Fulham, Hammersmith, Chswick, Shepherds Bush, South Kensington and Holland Park. They were booked utilising the West London Hospital Obstetric Optical Memory Project (OOMP),interactive computer system. This computer, used by the midwife, presented interactive screens to allow the booking interview to be conducted in a logical sequence. Information was collected and entered prospectively, with the client, to ensure the greatest degree of data accuracy. The computer recorded, as part of the booking interview, which investigations were initiated, including HIV antibody testing which is offered routinely to all antenatal clinic attenders. Also recorded was a complete obstetric, medical and social profile, as relevant to antenatal care, including identification of the midwife performing the pre-test counselling for each client. The database was interrogated using a database management system (DBASE4, Ashton Tate Ltd.) Uptake percentages were calculated for midwives counselling more than 12 clients during the year. Results
Twelve midwives were identified who had counselled more than 12 patients during the period. The other midwives had only counselled one or two women and so were not included in the analysis. Table 1 shows the acceptance and refusal rates for those midwives. Percentage uptake dffers greatly ranging from 81.8% to 3.4%, the mean uptake being 17% (~z=p
AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
Voluntary HIV testing in the antenatal clinic: Differing uptake rates for individual counselling midwives a
b
a
J. Meadows , S. Jenkinson , J. Catalan & B. Gazzard
c
a
Academic Department of Psychiatry , Charing Cross and Westminster Medical School , b
Department of Obstetrics & Gynaecology , West London Hospital ,
c
Westminster Hospital , Published online: 25 Sep 2007.
To cite this article: J. Meadows , S. Jenkinson , J. Catalan & B. Gazzard (1990) Voluntary HIV testing in the antenatal clinic: Differing uptake rates for individual counselling midwives, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 2:3, 229-233, DOI: 10.1080/09540129008257735 To link to this article: http://dx.doi.org/10.1080/09540129008257735
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
AIDS CARE, VOL. 2, NO. 3,1990
229
Downloaded by [JAMES COOK UNIVERSITY] at 09:04 17 March 2015
Voluntary HIV testing in the antenatal clinic: differing uptake rates for individual counselling midwives J. MEADOWS', S. JENKINSON~,J. CATALAN' & B.
GAZZARD3
'Academic Department of Psychiatry, Charing Cross and Westminster Medical School, ZDepartmentof Obstehics 13Gynaecology, West London Hospital and Westminster Hospital
Abstract This study looked at 12 midwives in the Riverside Health Authority who counselled parturient women about having the HIV antibody test. Results showed that the uptake rate of the test varied considerably across midwives (82% to 3%). Uptake rate varied, to some extenr, by ethnic group of the midimye; Afro-Caribbeans hawing 36% uptake, others 11%. However, the wide variatabn wizhin these groups suggests that ethnicity alone does not explain the di&ence in uptake rate. Factors which could be associated with uptake rate are the individual characteristics of both the midwije and of the antenatal clinic anender, such as age, ethnicity, knowledge of and am'tudes to HIV and antibody testing, as well as the counselling approach of the individual mideoije. Introduction The necessity for identifying women positive for HIV antibodies during pregnancy by voluntary testing remains an area of controversy. Results from the RCOG study of HIV infection in pregnancy in the United Kingdom show that in 46% of women who are HIV positive, the infection was identified by antenatal testing, Davison et al. (1989). It is unlikely that they would have been tested had they not become pregnant. However, as with any other medical test, health care professionals should question the value of testing for HIV. First, will future treatment or behaviour be affected? If not, then testing may be of little value. Secondly, what is the sensitivity and specificity of the test? If there is an unacceptably high proportion of false positive results yielded by the test, does this not throw its predictive value into question? In antenatal clinics in the United Kingdom, these are some of the considerations for the midwife counselling a woman about having an HIV antibody test. The midwife's primary responsibility is to ensure that the woman is aware of the possible advantages and disadvantages of HIV antibody testing. The midwife must point out that knowledge of HIV serologic status enables a woman to make an informed decision about her pregnancy and allows for appropriate care for herself and her child. It also allows for a change in sexual behaviour to prevent transmission of Address for correspondence: Jean Meadows, Prince of W d a Unit, Westminster Hospital, Dean Ryle Street, London SWl.
Downloaded by [JAMES COOK UNIVERSITY] at 09:04 17 March 2015
230
J. MWDOWS ET AL.
infection to partners in the future. It should be noted, however, that no relationship has been found between knowledge of serologic status and behaviour change in other populations such as gay men and intravenous drug users (Institute of Medicine, 1988). Current knowledge about the effect of HIV infection on pregnancy and of pregnancy on the course of HIV disease, vertical transmission rates, etc. should be offered in the decision making process. Is identification of HIV infection therefore critical for medical, ethical or statutory reasons? (Minkoff & Landesman, 1988). Consideration should be given to the possibility of economic loss as a result of testing when, for example, insurance premiums are increased. Also there is a possibility of false reassurance by a negative result. This aspect, the ‘certificate of health effect’ (Tymstra & Bieleman, 1987), describes individual’s inclination to regard a negative result as justification for their risky behaviour and thereby as a denial of a need for change. Other negative psychological effects should be considered such as the encouraging of a sense of invulnerability which makes individuals less likely to return for further testing (Marteau, 1989). In the Riverside Health Authority, in 1987, a policy began of offering HIV antibody testing to all clients of antenatal clinics at St Stephens and Westminster Hospitals. The uptake rate for that year was 74% (Howard er al., 1989). During 1989, St Stephens and Westminster merged with the West London Hospital resulting in a greatly reduced uptake of 17% (Jenkinson & Meadows, 1990). This study reports on the differences in uptake rate according to the counselling midwife. It is part of a series of investigations into factors associated with decisions about HIV testing in antenatal clinic attenders and the psychological effects of the procedure. This work is being carried out by a research team in the Department of Psychiatry, Charing Cross Hospital and the Kobler Centre.
Patients and methods Over a 12 month period ending February 1990, a total of 788 women were booked for intrapartum care in the Riverside Health Authority. These women came in the main from Riverside West: Fulham, Hammersmith, Chswick, Shepherds Bush, South Kensington and Holland Park. They were booked utilising the West London Hospital Obstetric Optical Memory Project (OOMP),interactive computer system. This computer, used by the midwife, presented interactive screens to allow the booking interview to be conducted in a logical sequence. Information was collected and entered prospectively, with the client, to ensure the greatest degree of data accuracy. The computer recorded, as part of the booking interview, which investigations were initiated, including HIV antibody testing which is offered routinely to all antenatal clinic attenders. Also recorded was a complete obstetric, medical and social profile, as relevant to antenatal care, including identification of the midwife performing the pre-test counselling for each client. The database was interrogated using a database management system (DBASE4, Ashton Tate Ltd.) Uptake percentages were calculated for midwives counselling more than 12 clients during the year. Results
Twelve midwives were identified who had counselled more than 12 patients during the period. The other midwives had only counselled one or two women and so were not included in the analysis. Table 1 shows the acceptance and refusal rates for those midwives. Percentage uptake dffers greatly ranging from 81.8% to 3.4%, the mean uptake being 17% (~z=p
