Factors affecting the adherence to an antenatal screening programme: an experience with toxoplasmosis screening in France

Monthly serological testing is mandatory in France for pregnant women not immune to toxoplasmosis. We assessed for the first time the adherence to this national programme, using data from antenatal tests for Toxoplasma antibodies collected by the Union of Health Insurance Services in the French Rhone-Alpes region. Data from 34,290 pregnancies was analysed. The first test was done late in 25% of women (8,430). Women had on average 5.7 tests during pregnancy, only 40 percent (13,774) were tested seven or more times as recommended. Young women were more likely to have a late first test, but age did not significantly influence regularity and number of tests. Free medical coverage favoured a late first test, fewer tests and longer between-test intervals. An early first test did not affect test numbers or between-test intervals. A re-useable prescription for several tests was associated with better adherence. Prescription by general practitioners was associated with an earlier first test, but fewer tests and longer between-test intervals. When prescribing physician(s) included a gynaecologist, the first test was more likely to be behind schedule, but the overall number of tests was higher and between-test intervals shorter. Because data was collected through private laboratories, our conclusions apply to the majority of French patients who need to schedule a separate visit for blood testing after prescription.