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

[Guest guest]

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

Labor in Rural India

Nitika Pant Pai1*, Ritu Barick2, P. Tulsky3, Poonam V.

Shivkumar2, Deborah Cohan3, Shriprakash Kalantri2, Madhukar Pai4,

Marina B. Klein1, Shakuntala Chhabra2

To whom correspondence should be addressed. E-mail:

nitika.pai@...

EDITORS' SUMMARY

Background.

Since the first reported case of AIDS (acquired immunodeficiency

syndrome) in 1981, the number of people infected with the human

immunodeficiency virus (HIV), which causes AIDS, has risen steadily.

Now, more than 33 million people are infected, almost half of them

women. HIV is most often spread through unprotected sex with an

infected partner, but mother-to-child transmission (MTCT) of HIV is

also an important transmission route. HIV-positive women often pass

the virus to their babies during pregnancy, labor and delivery, and

breastfeeding, if nothing is done to prevent viral transmission.

In developed countries, interventions such as voluntary testing and

counseling, safe delivery practices (for example, offering cesarean

delivery to HIV-positive women), and antiretroviral treatment of the

mother during pregnancy and labor and of her newborn baby have

minimized the risk of MTCT. In developing countries, the prevention

of MTCT (PMTCT) is much less effective, in part because pregnant

women often do not know their HIV status.

Consequently, in 2007, nearly half a million children became infected

with HIV mainly through MTCT.

Why Was This Study Done?

In many developing countries, women do not receive adequate antenatal

care. In India, for example, nearly half the women living in rural

areas do not receive any antenatal care until they are in labor. This

gives health care providers very little time in which to counsel

women about HIV infection, test them for the virus, and start

interventions to prevent MTCT. Furthermore, testing pregnant women in

labor for HIV and counseling them is a challenge, particularly where

resources are limited.

In this study, therefore, the researchers investigate the feasibility

and impact of introducing round-the-clock, rapid HIV testing and

counseling in a busy labor ward in a rural teaching hospital in

Sevagram, India.

What Did the Researchers Do and Find?

Women admitted to the labor ward between January and September 2006

were offered two rapid HIV tests—one that used a saliva sample and

the other that used blood taken from a finger prick. Blood was also

taken from a vein for conventional HIV testing. All the women were

given a 15-minute counseling session about how HIV is transmitted,

the importance of HIV testing, and information on PMTCT before their

child was born (prepartum counseling), and a longer postpartum

counseling session. HIV-positive women were given a cesarean delivery

where possible and antiretroviral drug treatment to reduce MTCT.

1,222 women admitted to the labor ward during the study period (1,003

of whom did not know their HIV status) accepted HIV testing. Of 15

study participants who were HIV positive, 11 learnt of their HIV

status in the labor room. Two babies born to these HIV-positive women

were HIV positive and died within a month of delivery; the other 13

babies were HIV negative at birth and at 1 and 4 months after

delivery. Finally, the rapid HIV tests missed only one HIV-positive

woman (no false-positive results were given), and the time from

enrolling a woman into the study through referring her for PMTCT

intervention where necessary averaged 40–60 minutes.

What Do These Findings Mean?

These findings show the feasibility and positive impact of the

introduction of round-the-clock pre- and postpartum HIV counseling

and rapid HIV testing into a busy rural Indian labor ward. Few of the

women entering this ward knew their HIV status previously but the

introduction of these facilities in this setting successfully

informed these women of their HIV status. In addition, the round-the-

clock counseling and testing led to 11 women and their babies

receiving PMTCT interventions who would otherwise have been missed.

These findings need to be confirmed in other settings and the cost-

effectiveness and sustainability of this approach for the improvement

of PMTCT in developing countries needs to be investigated.

Nevertheless, these findings suggest that round-the-clock rapid HIV

testing might be an effective and acceptable way to reduce MTCT of

HIV in many developing countries.

http://medicine.plosjournals.org/perlserv/?request=get-

document & doi=10.1371/journal.pmed.0050092