The effect of rapid HIV-1 testing on uptake of perinatal HIV-1 interventions: a randomized clinical trial.
OBJECTIVE
We examined whether HIV-1 testing using a rapid assay increases the proportion of pregnant women obtaining HIV-1 results and the uptake of perinatal HIV-1 interventions.


METHODS
Pregnant women attending public health clinics in Nairobi were offered voluntary counselling and testing for HIV-1. Consenting women were randomly assigned to receive either rapid or conventional HIV-1 testing. Women randomly assigned to rapid testing were allowed to receive same-day results or to return later. The results for women randomly assigned to conventional enzyme-linked immunosorbent assay (ELISA) testing were available after 7 days. HIV-1-infected women were referred for antiretroviral prophylaxis to prevent mother-to-child transmission of HIV-1.


RESULTS
Among 1282 women offered voluntary HIV-1 testing and counselling, 1249 accepted testing, of whom 627 were randomly assigned to rapid testing and 622 to conventional testing. The median duration between testing and obtaining results was 0 days for women who received rapid testing compared with 11 days for women who received conventional testing. The percentage receiving HIV-1 results was significantly higher among women who received rapid testing compared with conventional testing. Of 161 HIV-1-seropositive women, only 24 received antiretroviral prophylaxis. The uptake of perinatal HIV-1 interventions did not differ between HIV-1-seropositive women randomly assigned to rapid testing or conventional ELISA testing.


CONCLUSIONS
Rapid HIV-1 testing significantly increased the proportion of women receiving HIV-1 results, which is important for sexual and perinatal HIV-1 prevention. The challenge remains to improve the uptake of perinatal HIV-1 interventions among HIV-1-seropositive women.
Malonza
Isaac M
IM
Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. malonzai@who.int
Richardson
Barbra A
BA
Kreiss
Joan K
JK
Bwayo
Job J
JJ
Stewart
Grace C
GC
D015492:AIDS Serodiagnosis / Q000379:methods*; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D019380:Anti-HIV Agents / Q000008:administration & dosage; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control; D015497:HIV-1; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D012017:Referral and Consultation; D013997:Time Factors
D019380:Anti-HIV Agents