Research Team
- S Chambers [Dept of Infectious Diseases, Christchurch Hospital]
- KA Heckert [Dept of Public Health & General Practice, Christchurch School of Medicine and Health Sciences]
- J Ussher [Dept of Infectious Diseases, Christchurch Hospital]
- S Bagshaw [New Zealand Family Planning Association]
- M Birch [Dept of Infectious Diseases, Christchurch Hospital]
- MA Wilson [Dept of Public Health & General Practice, Christchurch School of Medicine and Health Sciences]
Background
The 1998 survey among maternity care providers in Dunedin found that 66% were unaware of the Ministry of Health's 1997 provider guidelines regarding antenatal screening for HIV and clinical management. Furthermore, 68% were unaware of the effective treatment available for HIV during antenatal care.
Objectives
The purpose of the Canterbury survey was to expand and extend the Dunedin study to investigate providers' perceptions and practices concerning HIV and pregnancy, particularly attitudes regarding antenatal HIV screening.
Methods
In October 1999, after being pilot tested, an anonymous self-administered questionnaire was sent to 728 maternity care providers in the South Island, excluding Otago and Southland; all registered general practitioners, all members of the Canterbury-West Coast Region of the NZ College of Midwives, and all obstetricians. By early December, after the initial mailing and only one posted reminder, a total of 418 providers had completed the survey, a response rate of 59%.
Results
This study results showed that the primary maternity care providers:
- strongly believed that knowing that a woman was HIV infected is beneficial to both mother (76%) and baby (88%),
- knew how to assess risk for HIV,
- saw themselves as having an important role in antenatal HIV testing, and
- were comfortable with performing risk assessment.
Despite this, only 65% thought that routine risk assessment should be performed, but in practice it was unusual for risk assessment to be carried out and even more unusual for an HIV test to be done. Explanations for the apparent discrepancy between opinion and practice were gleaned from the open-ended questions. Most respondents said they were comfortable doing risk assessment but some felt that the personal nature of questions and confidentiality issues were a barrier.
Others identified a lack of time, skills and experience as possible barriers to and an explanation for the differences in practice. Evidence from other countries shows that these issues need not interfere with good practice and that models of care can be developed which are readily acceptable and can be performed efficiently.
Conclusion
The advances in knowledge and efficacy of therapeutic interventions have stimulated many countries to ensure that transmission of HIV from mother to child is minimised. The current New Zealand policy of routine assessment of risk and testing is not working in the South Island as demonstrated by the fact that:
- providers are NOT assessing risk or screening for HIV, as this study shows and
- babies are being born with HIV in NZ.
In the United Kingdom research has shown that routine offering of an HIV test can be included in antenatal care in an efficient, cost-effective manner. Given that the prevalence of HV in the community in New Zealand is similar to the United Kingdom, NZ has a duty to seriously examine its practice.
Publications
- Chambers ST, Heckert K A, Bagshaw S, Ussher J, Birch M, Wilson M A. Maternity care providers' attitudes and practices concerning HIV testing during pregnancy; results of a survey of the Canterbury and upper South Island region. New Zealand Medical Journal 114: 513-6, 2001.