05/06/08

Impact of Round-the-Clock, Rapid Oral Fluid HIV Testing of Women in Labor in Rural India

In the present study, the researchers investigated the impact of providing continuously available rapid-result HIV testing and counseling in a busy labor ward of a tertiary care hospital in rural India.

Written informed consent was obtained from women admitted to the labor ward of a rural teaching hospital in India. The women were offered two rapid tests on oral fluid and finger-stick specimens (OraQuick Rapid HIV-1/HIV-2 tests from OraSure Technologies). At the same time, venous blood was drawn for conventional ELISA HIV testing. Western blot tests were performed for confirmatory testing for women who tested positive on both rapid tests and dual ELISA or whose tests results were discordant. As part of the strategy, round-the-clock abbreviated prepartum and extended postpartum counseling was offered. Prevention of mother-to-child transmission (PMTCT) measures were administered for the women who were HIV positive.

During a nine-month period in 2006, 1,252 eligible women ages 18 to 38 were asked for their consent, of which 1,222 (98 percent) accepted testing. No previous testing or incomplete testing results were reported by 1,003 (82 percent). Fifteen of the women who underwent testing were diagnosed as HIV-positive for a seroprevalence rate of 1.23 percent (95 percent confidence interval 0.61-1.8 percent). Four of the 15 (27 percent) had presented with reported HIV status, and 11 (73 percent) new cases of HIV were detected by the labor room testing. Therefore, 11 HIV-positive women received PMTCT interventions as a result of the labor room testing and counseling. Both OraQuick tests were 100 percent specific, but one false negative was documented with both oral and finger-stick methods. Among the 15 HIV-positive women, 13 infants were HIV-negative at birth and at one and four months, while two babies were HIV-positive and died within one month of birth.

"In a busy rural labor ward in India, we demonstrated that it is feasible to introduce a program of round-the-clock rapid HIV testing, including prepartum and extended postpartum counseling sessions," the authors concluded. "Our data suggest that the availability of round-the-clock rapid HIV testing resulted in successful documentation of HIV serostatus in a large population (82 percent) of rural women who were unaware of their HIV status when admitted to the labor room. In addition, 11 (73 percent) of a total of 15 HIV-positive women received PMTCT interventions because of round-the-clock rapid testing in the labor ward. These findings are relevant for PMTCT programs in developing countries."

Source: PLoS Medicine Vol. 5; No. 5: P. e92 doi: 10.1371/journal.pmed.0050092:: Nitika Pant Pai; Ritu Barick; Jacqueline P. Tulsky; Poonam V. Shivkumar; Deborah Cohan; Shirprakash Kalantri; Madhukar Pai; Marina B. Klein; Shakuntala Chhabra; Courtesy of the CDC National Center for HIV, STD, and TB Prevention