Rapid HIV Testing of Women in Labor

Abstract

For HIV-infected women who have not received antiretroviral treatment or transmission prophylaxis in pregnancy, starting antiretrovirals in labor or soon after birth can still decrease the risk of perinatal transmission. There is, therefore, potential benefit in conducting rapid HIV testing in labor, but hospitals are seldom prepared to conduct such testing. We compared protocols for rapid HIV testing at 2 hospitals to determine what proportion of women had results back early enough to intervene if results had been positive. Hospital A initially used HIV enzyme-linked immunosorbent assays (ELISAs) and changed to using rapid tests (eg, Single Use Diagnostic System [SUDS]); hospital B used only the SUDS. With use of the SUDS in hospital A, results were reported more quickly than with the ELISA protocol in the same hospital (P < 0.0001). Comparing use of the SUDS in the 2 hospitals, test results were available more quickly in hospital A than hospital B (P < 0.05), which resulted in hospital A having more results reported prior to delivery (64% vs. 38%, P < 0.05) and within 12 hours postdelivery (94% vs. 73%, P < 0.05). If HIV testing in labor is to have its maximum effect on decreasing the risk of perinatal HIV transmission, hospitals need to institute rapid HIV testing, but protocols must ensure that results are available as quickly as possible.

Rapid HIV testing: A review of the literature and implications for the clinician

“…However, this is not always feasible and many pregnant women first present to the health care system at the time of labor, and therefore their HIV serostatus is not known [32,33]. The availability of rapid tests allows for HIV testing to be conducted at the time of labor thus allowing the knowledge of the mother's HIV-status which provides a "window of opportunity" for interventions to reduce HIV-perinatal transmission [34,35].…”

Provider-related Barriers to Rapid HIV Testing in U.S. Urban Non-profit Community Clinics, Community-based Organizations (CBOs) and Hospitals

“…Point-of-care rapid testing during labor enables providers to take effective, expedient measures to prevent perinatal HIV transmission (ACOG Committee on Obstetric Practice, 2004; Bulterys et al 2004;Centers for Disease Control and Prevention 1994;Cohen et al 2003;Forsyth et al 2004;Guay et al 1999;Kelen et al 1999), and rapid testing of source patients after occupational exposure facilitates employee decisions about post-exposure prophylaxis (Landrum et al 2005).…”

Feasibility and Acceptability of Rapid HIV Testing in Jail

“…Rapid HIV testing programs have successfully delivered point-of-care test results in a variety of settings including labor and delivery, outpatient clinics, and emergency rooms. [13][14][15][16] Experience with rapid HIV testing in jails is limited. One recent study showed rapid testing in a jail was feasible but had a relatively low acceptance rate.…”