CORE Center, Chicago, IL. and CDC, Atlanta, GA
Although all women should be screened for HIV during the antenatal period, an estimated 10%-15% of HIV-infected mothers do not access care before labor and delivery (L&D). Point-of-care rapid HIV testing in obstetric units could help L&D staff identify and offer prophylactic treatment to HIV-infected women in time to reduce perinatal HIV transmission.
Four (4) Chicago hospitals participating in the CDC multi-city Mother Infant Rapid Intervention at Delivery (MIRIAD) study implemented the rapid testing protocol. Trained obstetric staff performed rapid testing themselves on the L&D unit in three hospitals. In the fourth hospital, the rapid test was run in the laboratory. After determining eligibility and obtaining informed consent, blood was drawn for the OraQuick rapid HIV test and confirmatory standard testing. We also determined the median time from drawing of the participant's blood to informing her of her test results at each hospital.
From November 2001 to July 2002, 6,262 women presented to the four Chicago obstetric units and 610 were eligible for rapid testing (>24 weeks pregnant and no documented HIV results available to L&D staff). Of these, 453 consented to participate and were tested with OraQuick. Three (3) previously undetected HIV-infected women were identified and started on antiretroviral prophylaxis. in the three hospitals where nurses, midwives, or physicians performed the rapid test at point-of-care), median turn around time was 45 minutes (range 20 mins to 3 hrs). At the hospital where the laboratory performed the rapid test, median turn around time was 3 hrs (range 90 mins to patient never informed of result). Delays in delivering rapid test results were due to shift change in the laboratory, staff not calling for the result after the test was sent to the laboratory, patient sleeping, or patient having left the unit before test results were returned.
Point-of-care rapid HIV testing by staff attending women in labor provides a more timely method to identify and treat women with HIV who had not been tested during their pregnancy than does conducting the rapid HIV tests in the hospital laboratory. L&D staff can be trained to perform onsite rapid testing and then offer peripartum antiretroviral prophylaxis that can further reduce perinatal HIV transmission in the U.S.