Policy lags behind reality on antenatal HIV screening

To the Editor: I wholeheartedly agree with Giles at al1 regarding the need for universal HIV antenatal screening in Australia. However, it is worth noting that, at least in private practice, there is already a significant amount of antenatal HIV screening taking place. In November 2005, several Medicare Benefits Schedule (MBS) item numbers were introduced for antenatal screening for infectious diseases including HIV testing. I am unaware of any specific HIV-testing restrictions relating to national policy (other than the obligations of informed consent and such like) attached to these item numbers.

Four MBS item numbers for “microbiological serology during a pregnancy” may include HIV testing (69405, 69408, 69411 and 69413), and one MBS item number (69415) must include HIV testing. From November 2005 to June 2006, there were 137 732 claims for antenatal serological tests, of which at least 46 085 (33%) included HIV testing (see Box).2 There is some variation from state to state (New South Wales, 25%; Victoria, 34%; and Queensland, 38.5%). Significant state-to-state variation of claims for different Medicare items is not unusual but, in this case, it does not appear to follow any pattern (of the epidemiology of HIV infection in Australia). I suspect that the proportion of pregnant women having HIV tests is closer to 50%, assuming that at least some of the other item numbers claimed included testing for HIV.

It would be worthwhile taking these figures into account when formulating national policy.