care be offered an HIV test. Meeting this target requires that prenatal care providers be aware of the benefits of maternal HIV screening and adopt practices to ensure that all pregnant women are counseled and offered testing. A total of 22 recent studies (conducted from 1994 to 1997) of prenatal care providers' attitudes and practices regarding HIV counseling and testing have been identified, and are summarized in Table 6.1. These studies were conducted in 22 states, and all involved surveys of prenatal care providers. The specific methods of study varied somewhat (e.g., telephone versus mail administration of survey), as did the sampling (representative versus convenience samples) and the response rates (from 25% to 84%). Many of the studies were unpublished at the time of this review and therefore have not been subject to peer review. Because most of the literature on provider behavior is based on surveys that rely on self-reports, there is a possibility of biased reporting favoring compliance with recommended practice. It is difficult to draw a national picture from the results of these selected states, but there does appear to be significant variation across geographic areas and significant gaps between provider awareness and application of recommended practices.

Awareness of CDC's guidelines, state HIV testing laws, and the ACTG 076 results appears to vary among prenatal care providers:

  • In 1997, 60% of prenatal care providers in Oregon were familiar with CDC's recommendations regarding perinatal HIV transmission (Rosenberg et al., undated abstract).
  • In 1996, 92% of Michigan providers were aware of state HIV laws (Michigan Department of Community Health, 1997).
  • In 1996, 93% of Wisconsin providers had read a position paper, attended continuing education programs, or implemented an HIV testing policy (Wisconsin AIDS/HIV Program, 1997).
  • In 1996, 87% of Montana's obstetric providers were aware of CDC recommendations for testing pregnant women for HIV (Montana Department of Public Health and Human Services, 1996).
  • In 1995, 75% of California obstetricians were familiar with state law regarding HIV testing (Segal, 1996).
  • In 1995, 90% of North Carolina providers had heard of the ACTG 076 results, but fewer providers reported familiarity in later years in Colorado (75% in 1996) and Atlanta, Georgia (60% in 1997) (Newton and Bell, 1997; Walter et al., 1998; Nyquist, undated abstract).

Provider surveys, on the other hand, indicate substantial variability in clinical practices and significant gaps between recommended and reported practices:

  • In 1997, 94% of providers in New Jersey said they offered HIV testing to all or most of their prenatal patients (Ching et al., 1997).


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