Background:  In the United States, an unacceptably high percentage of pregnant women do not undergo prenatal HIV testing. Several observational studies have found increased uptake of prenatal HIV testing with streamlined pre-test counseling. There have been few trials to assess patient perspectives on and testing uptake associated with abbreviated pre-test counseling.

Methods:  This study was a randomized-controlled, non-inferiority trial of abbreviated versus standard pre-test HIV counseling among English- and Spanish-speaking pregnant women. All participants received either abbreviated or standard pre-test counseling at the initial prenatal visit, and, then, blinded study staff administered the low-literacy O’Connor Decisional Conflict Scale (DCS). We evaluated differences between the study arms in the proportion of women with low decisional conflict (DCS score <25), mean knowledge scores, proportion of women reporting overall satisfaction with their decision regarding HIV testing and uptake of HIV testing using χ² or Student’s t-tests as appropriate.

Results:  This final intention-to-treat analysis is based on 278 women enrolled:  134 (48.2%) in the abbreviated arm, and 144 (51.8%) in the standard arm. Women in the 2 groups were similar at baseline, with no statistically significant differences in age, race/ethnicity, or primary language. There was no significant difference in the proportion of women with low decisional conflict (71.6% in abbreviated arm vs 76.4% in standardized arm, p = 0.37), and the observed difference did not exceed the non-inferiority margins. Likewise, women in the 2 arms expressed similar overall satisfaction with their decision to test for HIV (97.8% in abbreviated arm vs 99.3% in standardized arm, p = 0.34). However, women in abbreviated arm had significantly lower mean knowledge scores (78.4% correct) compared to women in standardized arm (83.7% correct, p <0.01). Overall testing uptake was very high (97.5%) and did not differ significantly between the 2 groups (98.5% in abbreviated arm vs 96.5% in standardized arm, p = 0.17).

Conclusions:  This study suggests that streamlining the pre-test counseling process, while associated with less knowledge, does not compromise patient decision making or satisfaction regarding HIV testing. While there were no differences seen in testing uptake in our study, universal, abbreviated pre-test counseling will likely be easier to systematically implement in the prenatal setting and may be associated with increased HIV testing rates on a population level.