Rapid HIV-1 testing during labor: a multicenter study.
BACKGROUND
Timely testing of women in labor with undocumented human immunodeficiency virus (HIV) status could enable immediate provision of antiretroviral prophylaxis.


OBJECTIVE
To determine the feasibility and acceptance of rapid HIV testing among women in labor and to assess rapid HIV assay performance.


METHODS
The Mother-Infant Rapid Intervention At Delivery (MIRIAD) study implemented 24-hour counseling and voluntary rapid HIV testing for women in labor at 16 US hospitals from November 16, 2001, through November 15, 2003. A rapid HIV-1 antibody test for whole blood was used.


METHODS
Acceptance of HIV testing; sensitivity, specificity, and predictive value of the rapid test; time from blood collection to patient notification of results.


RESULTS
There were 91,707 visits to the labor and delivery units in the study, 7381 of which were by eligible women without documentation of HIV testing. Of these, 5744 (78%) women were approached for rapid HIV testing and 4849 (84%) consented. HIV-1 test results were positive for 34 women (prevalence = 7/1000). Sensitivity and specificity of the rapid test were 100% and 99.9%, respectively; positive predictive value was 90% compared with 76% for enzyme immunoassay (EIA). Factors independently associated with higher test acceptance included younger age, being black or Hispanic, gestational age less than 32 weeks, and having had no prenatal care. Lower acceptance was associated with being admitted between 4 pm and midnight, particularly on Friday nights, but this may be explained in part by fewer available personnel. Median time from blood collection to patient notification of result was 66 minutes (interquartile range, 45-120 minutes), compared with 28 hours for EIA (P<.001).


CONCLUSIONS
Rapid HIV testing is feasible and delivers accurate and timely test results for women in labor. It provides HIV-positive women prompt access to intrapartum and neonatal antiretroviral prophylaxis, proven to reduce perinatal HIV transmission, and may be particularly applicable to higher-risk populations.
Bulterys
Marc
M
Division of HIV/AIDS Prevention, Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA. mbulterys@cdc.gov
Jamieson
Denise J
DJ
O'Sullivan
Mary Jo
MJ
Cohen
Mardge H
MH
Maupin
Robert
R
Nesheim
Steven
S
Webber
Mayris P
MP
Van Dyke
Russell
R
Wiener
Jeffrey
J
Branson
Bernard M
BM
D015492:AIDS Serodiagnosis / Q000379:methods*; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood*; D036861:Delivery, Obstetric; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D007743:Labor, Obstetric; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D012680:Sensitivity and Specificity
D000914:Antibodies, Viral