Routine HIV counseling and testing during antenatal care in Ukraine: A qualitative study of the experiences and perspectives of pregnant women and antenatal care providers

Ukraine has one of the highest levels of HIV prevalence in Europe. Provider-initiated HIV testing and counseling (PITC) is routine during antenatal care (ANC) in Ukraine, with nearly all pregnant women receiving HIV testing. National policies state that testing is voluntary, with consent and confidentiality protections, but little is known about actual testing implementation and adherence to these policies. A qualitative study was conducted to explore women's and providers' experiences of HIV testing during ANC, with a focus on consent, counseling, and confidentiality. In-depth interviews were conducted at two urban women's clinics and one semi-urban women's clinic in Donetsk, one of the most HIV-affected regions in Ukraine. Interviews targeted HIV-positive and HIV-negative women recently tested during ANC, as well as health providers involved in administering HIV tests during ANC. Interview analysis revealed gaps between policies and practices, as well as differences in perceptions of aspects of PITC between women and providers. Notable findings included: wide variation in informed consent procedures; providers reporting feeling unequipped to provide adequate counseling; and post-testing practices that may jeopardize patient confidentiality, particularly in the semi-urban site. These findings suggest the need for additional training and support, especially outside major cities, to ensure that HIV testing practices during ANC adhere to Ukrainian policy and global principles regarding PITC.