Repeat antenatal HIV testing in the third trimester: a study of feasibility and maternal uptake rates

Abstract

The study aimed to assess the feasibility and acceptability of third-trimester antenatal HIV testing within our service after two cases of HIV seroconversion in pregnancy were noted in 2008. North American Guidelines recommend universal third-trimester HIV testing in areas with an HIV prevalence of more than 1 per 1000. The HIV prevalence rate in our area is 3.01 per 1000. MethodsPregnant women prior to 28 weeks of gestation were recruited at booking between 1 September 2008 and 31 August 2009 and offered an additional third-trimester HIV test. Consent was obtained and testing was performed by hospital and community midwives. Information was entered into a modified existing electronic maternity database. A qualitative e-mail survey of midwives investigated barriers to participation in the study. ResultsA total of 4134 women delivered; three (< 0.1%) declined first-trimester testing. Twenty-two women (0.5%) tested HIV positive, of whom six were newly diagnosed. Overall, 2934 of 4134 women (71%) were offered and accepted a third-trimester HIV test and had results available. Data were unavailable for 195 women (4.7%). A total of 663 of 4131 women (16%) were not offered a third-trimester test. Of 3273 women documented as having been offered a test, 3177 (97.1%) accepted. There were no positive third-trimester tests. Forty of 50 (80%) midwives surveyed responded with questionnaire feedback and cited lack of national policy and extra workload as barriers to performing third-trimester testing. ConclusionsThird-trimester testing was feasible and consent rates were high in those offered repeat testing. Third-trimester testing has the potential to prevent paediatric HIV infection and universal testing should be considered in high-prevalence areas.Keywords: HIV testing, pregnancy, third trimester Accepted 1 October 2013 IntroductionFull adherence to national prevention of mother-to-child transmission of HIV guidelines has reduced the transmission rate from around 25% without intervention to less than 1% annually [1]. An audit exploring factors behind perinatal HIV transmission in 87 children between 2002 and 2005 concluded that around 70% were born to undiagnosed women and at least 20% of mothers had tested negative in pregnancy [2]. Thus, identifying seroconversion in pregnancy could help reduce mother-to-child HIV transmission further.US guidelines [3] recommend universal repeat thirdtrimester HIV screening for women receiving care in facilities where at least one HIV infection is diagnosed per 1000 pregnant women screened. In the last decade, approximately 1 in 250 women who booked with North West London Hospitals (NWLH) NHS Trust were HIV positive. In 2006, the perinatal HIV group at NWLH NHS trust observed two cases of HIV seroconversion in pregnancy. There is additionally one HIV-infected child in our service whose mother tested HIV negative in the first trimester of pregnancy and who reportedly mixed breast and bottle fed for 2 months after delivery.Following discussion among the Trust's multidisciplinary perinatal ...

HIV acquisition during pregnancy and postpartum is associated with genital infections and partnership characteristics

“…[6, 39–41] In a recent US study, 97% of women offered retesting in pregnancy accepted. [40] In Kenya, ~95% of >2,000 women accepted HIV retesting at 6 weeks postpartum. [6] However, repeat testing is infrequently performed due to erratic availability of test kits, concerns of increased workload, late ANC initiation and low emphasis by programs.…”

“…[6] However, repeat testing is infrequently performed due to erratic availability of test kits, concerns of increased workload, late ANC initiation and low emphasis by programs. [6, 40] Addressing these challenges would enhance early detection of incident maternal HIV infections and enable prompt ART initiation to decrease vertical HIV transmission. Clinical detection of acute HIV is poor - symptoms are often non-specific or absent.…”

Implementation of repeat HIV testing during pregnancy in Kenya: a qualitative study

“…Previous literature has documented the barriers to an initial antenatal HIV test among pregnant women, as well as barriers to HIV retesting in other populations who have been tested at least once [ 8 – 10 ]. This study focused on the barriers to repeat HIV testing among pregnant women in sub-Saharan Africa, a strategy that experts have called for to address incident HIV during pregnancy and the associated high risks of HIV-related maternal mortality and MTCT to infants [ 2 ].…”

“…Much research has been done on the barriers to initial HIV testing in sub-Saharan Africa among the general population, identifying factors such as stigma, lack of information, perceptions of lack of privacy and confidentiality, poor relationships with health staff, and fear of being HIV-positive [ 8 , 9 ]. However, the barriers and enablers to repeat HIV testing among pregnant women who have already accepted HIV testing once are less clear [ 10 ].…”

Paediatric HIV grows up: recent advances in perinatally acquired HIV

“…Rarely, transmission has occurred following a negative HIV test in early pregnancy, presumably as a result of in utero, perinatal or breast milk transmission following maternal infection late in pregnancy. Feasibility of selective repeat screening in third trimester in high-prevalence areas is under consideration, although not currently recommended 15. Transmission has also occurred despite antenatal diagnosis in the context of a diagnosis made late in pregnancy, premature delivery or presumed early in utero transmission.…”