Universal Rapid HIV Testing During Labor Feasible in Developing Countries

CHENNAI, India (Reuters Health) May 09 - Rapid oral-fluid testing for HIV, counseling, and mother-to-child transmission (MTCT) prophylaxis in all women at the time of delivery are feasible and cost-effective in resource-poor settings, according to the results of a study from India.

A large proportion of women in resource-poor settings do not have access to antenatal care and miss out on HIV testing and MTCT prevention measures during pregnancy, note Dr. Nitika Pant Pai and colleagues. “Delivery is the last opportunity.”

Dr. Pai, from McGill University in Montreal, Canada, and her associates introduced round-the-clock rapid HIV testing in a busy labor ward at the Mahatma Gandhi Institute of Medical Sciences, Wardha, in central India.

The team offered 1252 women two rapid HIV tests, one using oral fluid and the other through finger blood samples, and 1222 women consented. When one or both tests were positive, results were confirmed with dual ELISA Western blot tests.

Women testing positive were given rapid prepartum counseling for around 15 minutes, postpartum counseling and MTCT prophylaxis intrapartum and postpartum as per existing protocols. Their infants received antiretrovirals in the first week postpartum and HIV RNA testing within 2 days postpartum, at 1 month and 4 months of age.

Fifteen women in the study group tested HIV positive, the researchers report in the May issue of PLoS Medicine. Intrapartum and postpartum MTCT prophylaxis was administered to 14 women, while 1 woman received only postpartum prophylaxis because of initial negative tests, they note.

Two infants born to HIV-positive mothers were HIV RNA positive at 48 hours postpartum and did not survive the neonatal period, while the remaining 13 were HIV-negative at the end of 4 months, the researchers found.

The diagnostic accuracy of both the rapid tests was the same, with a sensitivity of 93.3% and specificity of 100%, Dr. Pai’s team observed.

The complete process from testing to MTCT prevention took less than an hour, which is feasible in most delivery centers, they add.

“It is possible to use one oral test and confirm it with ELISA and Western Blot, or use two rapid tests of different antigenic specificities in a serial or parallel testing format, which is recommended by WHO. The novelty of oral testing is the convenience, to the patient, the physicians, the counselors,” Dr. Pai told Reuters Health.

When asked about the feasibility of implementation on a large scale, Dr. Pai said, “Yes, it is doable.” The resources needed “are nominal, if you consider the long-term resources needed to treat HIV-infected children,” she added.

“A large number of women first encounter the medical care system during active labor,” Dr. David D. Celentano from the Johns Hopkins Bloomberg School of Public Health and author of a related editorial told Reuters Health. “The only opportunity for HIV testing is during labor and delivery,” he said.

“Scaling up this program is clearly the next challenge,” he commented.

1. Universal Rapid HIV Testing During Labor Feasible in Developing Countries