HIV rapid testing as a key strategy for prevention of mother-to-child transmission in Brazil.
OBJECTIVE
To assess the feasibility of HIV rapid testing for pregnant women at maternity hospital admission and of subsequent interventions to reduce perinatal HIV transmission.


METHODS
Study based on a convenience sample of women unaware of their HIV serostatus when they were admitted to delivery in public maternity hospitals in Rio de Janeiro and Porto Alegre, Brazil, between March 2000 and April 2002. Women were counseled and tested using the Determine HIV1/2 Rapid Test. HIV infection was confirmed using the Brazilian algorithm for HIV infection diagnosis. In utero transmission of HIV was determined using HIV-DNA-PCR. There were performed descriptive analyses of sociodemographic data, number of previous pregnancies and abortions, number of prenatal care visits, timing of HIV testing, HIV rapid test result, neonatal and mother-to-child transmission interventions, by city studied.


RESULTS
HIV prevalence in women was 6.5% (N=1,439) in Porto Alegre and 1.3% (N=3.778) in Rio de Janeiro. In Porto Alegre most of women were tested during labor (88.7%), while in Rio de Janeiro most were tested in the postpartum (67.5%). One hundred and forty-four infants were born to 143 HIV-infected women. All newborns but one in each city received at least prophylaxis with oral zidovudine. It was possible to completely avoid newborn exposure to breast milk in 96.8% and 51.1% of the cases in Porto Alegre and Rio de Janeiro, respectively. Injectable intravenous zidovudine was administered during labor to 68.8% and 27.7% newborns in Porto Alegre and Rio de Janeiro, respectively. Among those from whom blood samples were collected within 48 hours of birth, in utero transmission of HIV was confirmed in 4 cases in Rio de Janeiro (4/47) and 6 cases in Porto Alegre (6/79).


CONCLUSIONS
The strategy proved feasible in maternity hospitals in Rio de Janeiro and Porto Alegre. Efforts must be taken to maximize HIV testing during labor. There is a need of strong social support to provide this population access to health care services after hospital discharge.
Veloso
Valdiléa G
VG
Laboratório de Pesquisa em DST/AIDS, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil. vgveloso@ipec.fi ocruz.br
Bastos
Francisco I
FI
Portela
Margareth Crisóstomo
MC
Grinsztejn
Beatriz
B
João
Esau Custodio
EC
Pilotto
Jose Henrique da Silva
JH
Araújo
Ana Beatriz Busch
AB
Santos
Breno Riegel
BR
Fonseca
Rosana Campos da
RC
Kreitchmann
Regis
R
Derrico
Monica
M
Friedman
Ruth Khalili
RK
Cunha
Cynthia B
CB
Morgado
Mariza Gonçalves
MG
Saines
Karin Nielsen
KN
Bryson
Yvonne J
YJ
D015492:AIDS Serodiagnosis; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D012959:Socioeconomic Factors; D055815:Young Adult; D015215:Zidovudine / Q000008:administration & dosage
D019380:Anti-HIV Agents; D015215:Zidovudine