title: Predictors of rapid HIV testing acceptance and successful nevirapine administration in Zambian labor wards.
abstract: BACKGROUND
  Provision of HIV testing in labor provides an opportunity to reach susceptible women and infants.
  
  
  METHODS
  As part of a cluster randomized trial of labor ward-based prevention of mother-to-child transmission services in Lusaka, Zambia, we determined predictors of testing acceptance and nevirapine (NVP) administration in labor. HIV counseling and testing were offered to women unaware of their HIV status. NVP was administered to women who tested positive, and an inert (calcium) tablet was provided to women who tested negative, to avoid stigmatization.
  
  
  RESULTS
  Among the 2435 women who presented in labor, 393 (16%) were unaware of their HIV status, of whom 278 (71%) met eligibility criteria. We offered counseling to 217 (78%) of eligible women: 146 (67%) agreed, 82 (56%) of those counseled were tested for HIV, and 23 (28%) were seropositive. Testing rates were higher among primigravida women [adjusted odds ratio (AOR) 1.5; 95% confidence interval (CI): 1.1 to 2.1] and among those not offered HIV testing during their pregnancy (AOR 3.7; 95% CI: 2.8 to 5.1). Cervical dilation <or=3 cm at the time of admission was associated strongly with NVP ingestion >1 hour (AOR 11.5; 95% CI: 4.5 to 29.2) and >2 hours (AOR 11.4; 95% CI: 4.7 to 27.5) before delivery.
  
  
  CONCLUSIONS
  Labor ward HIV testing is feasible in this resource-limited setting.
authors: School of Public Health, Department of Epidemiology, University of Alabama, Birmingham, AL, USA. kmegazzini@gmail.com
authors: Karen M
authors: KM
authors: Megazzini
authors: Namwinga
authors: N
authors: Chintu
authors: Sten H
authors: SH
authors: Vermund
authors: David T
authors: DT
authors: Redden
authors: Daniel W
authors: DW
authors: Krebs
authors: Maureen
authors: M
authors: Simwenda
authors: Bushimbwa
authors: B
authors: Tambatamba
authors: Moses
authors: M
authors: Sinkala
authors: Jeffrey S A
authors: JS
authors: Stringer
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D007743:Labor, Obstetric; D025202:Molecular Diagnostic Techniques / Q000706:statistics & numerical data*; D019829:Nevirapine / Q000627:therapeutic use*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D015024:Zambia
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine