HIV voluntary counseling and testing of couples during maternal labor and delivery: the TRIPAI Couples study.
BACKGROUND
Women in Brazil are routinely tested for HIV-1 during pregnancy with rapid testing repeated during labor in some settings. Partner testing is not routinely offered. The peripartum period provides opportunity for HIV testing of couples.


METHODS
A cross-sectional study was conducted in a large public hospital in southern Brazil. HIV rapid testing was offered to all pregnant women in labor. Male partners of women who consented to partner inclusion were offered testing. Within HIV-serodiscordant couples, HIV-negative individuals were evaluated for the delta-32 base-pair CCR5 deletion allele.


RESULTS
From February to September 2009, 2888 women delivered, with 1729 eligible women approached for study participation; 1648 (95%) HIV-negative women consented to partner testing and 66% of partners accepted testing. Seven HIV-infected men (0.6%) with no prior diagnosis were identified. Testing strategies uncovered 7 additional serodiscordant couples, 4 HIV-infected women diagnosed at delivery, and 3 HIV-infected men who had not disclosed their status to their partners, for a total serodiscordance rate of 1.3% in 1101 couples. No cases of acute maternal or infant infection were noted. No delta-32 base-pair deletions were identified in 14 HIV-negative partners in serodiscordant relationships. Parameters associated with increased acceptance of partner testing included higher income (P = 0.003), education (P < 0.0001), stable relationships of longer duration (P = 0.001), and female support of partner testing (P < 0.0001).


CONCLUSIONS
Testing of couples at the time of labor and delivery is a feasible public health strategy in areas of moderate-to-high HIV prevalence, which can potentially prevent acute infections in men, women, and infants.
Grupo Hospitalar Conceiçao, Porto Alegre, Brazil.
Marineide
M
Melo
Ivana
I
Varella
Andrea
A
Castro
Karin
K
Nielsen-Saines
Rita
R
Lira
Mariana
M
Simon
Nava
N
Yeganeh
Taui
T
Rocha
José Artur
JA
Bogo Chies
Breno
B
Santos
D015492:AIDS Serodiagnosis / Q000379:methods*; D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D003376:Counseling; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000235:genetics / Q000517:prevention & control* / Q000635:transmission; D006679:HIV Seropositivity; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D058725:Peripartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D015995:Prevalence; D019713:Receptors, CCR5 / Q000235:genetics*; D017384:Sequence Deletion; D012747:Sexual Partners; D055815:Young Adult
C584933:CCR5 protein, human; D019713:Receptors, CCR5