Rapid HIV Type 1 Testing of Women Presenting in Late Pregnancy with Unknown HIV Status in Lima, Perú

Abstract

We studied the feasibility and acceptability of HIV-1 testing using rapid serological assays in pregnant women presenting in late pregnancy without prior HIV-1 testing. Pregnant women presenting to the emergency room at the Instituto Materno-Perinatal in Lima, Peru, were offered on-site rapid HIV-1 testing. Consenting women were provided HIV counseling and had samples taken for rapid detection of antibodies in the blood and oral secretions. Women testing HIV-1 seropositive by one or both assays were offered standard HIV obstetrical care including antiretrovirals. Between October 2000 and August 2001, 3543 women were tested for HIV-1 antibodies through the rapid testing protocol. Twenty-seven women tested positive by one or both assays. Standard EIA results were negative for two of the 27 women and EIA results were not available for an additional three women. Seventeen of the 19 women (89%) for whom delivery information is available received antiretroviral therapy prior to delivery. Eighty percent of the women treated with nevirapine received the drug at least 1 hr prior to delivery. Study personnel reported problems with performing the rapid assays for less than 1% of the samples and the majority of the women did not express a preference for either the oral fluid or blood sample collection. While HIV-1 testing early in pregnancy is preferable, rapid HIV-1 testing in late pregnancy or at delivery is feasible, acceptable to most women, and allows for timely intervention to reduce maternal-child transmission.

Effect of Point-of-Care Diagnostics on Maternal Outcomes in Human Immunodeficiency Virus–Infected Women

“…The impact of POC diagnostics on the target population, HIV-infected women, was not clearly defined in four studies (31–34). One study was aimed at determining the feasibility and acceptability of HIV rapid tests in pregnant women presenting in late pregnancy without prior HIV testing (35). Two studies were aimed at determining the accuracy and performance of the diagnostics (36, 37).…”

Is it Feasible to Use an Oral-Fluid Based Rapid Test Facilitated by Frontline Workers to Improve HIV Screening of Pregnant Women in Indian Rural Settings?

“…All remits of ethical principles involving human participants were followed for this study [19]. Informed written consent was obtained from all the participants (pregnant women and FLWs).…”

Use of rapid HIV antibody testing for controlling the HIV pandemic

“…The number of false-positive determinations using HIV RTs has been surprisingly small even in low HIV prevalence populations where specificity would be expected to be reduced. International studies (USA, Peru, Thailand and India) have all shown HIV RTs specificities of 99.9% or greater in a population from antenatal clinics, sexually transmitted infection clinics and individuals having HIV occupational exposures [22][23][24][25][26][27]. The recent WHO report including ten HIV RTs tested on a wellcharacterized panel found specificities greater than 94.6% with four tests having 100% [28].…”

“…However, the combination of RTs in either serial or parallel algorithms improves the overall specificity and, in practice, few dual RT reactive/reference test-negative errors have been observed and it is unclear whether these are test or process related [24,31].…”

“…Implementing an RT program can be delayed when facilities are inadequate for addressing initial and supplemental testing in a manner that preserves client privacy and anonymity [24]. Protocols must be in place that will reduce the risk of client identification should a confirmatory specimen be required.…”