Rapid HIV testing and obstetrical characteristics of women with unknown HIV serostatus at time of labor and delivery

Prevalence and predictors of unknown HIV status among women delivering in Mulago National Referral Hospital, Kampala, Uganda

INTRODUCTION

Knowledge of a person's HIV status during pregnancy is critical for prevention of mother to child transmission of HIV.

OBJECTIVES

To determine the prevalence and factors associated with unknown HIV status among women delivering in Mulago Hospital.

METHODS

This was a cross-sectional study of women that had just delivered. The women's demographic characteristics, health seeking behaviour, health system-related factors and knowledge on PMTCT were collected. Fisher's exact test, Wilcoxon rank sum test and logistic regression were used to test associations.

RESULTS

The prevalence of unknown HIV status was 2.6% (10/382). Attending ANC at higher level facilities (OR =0.1 95% CI 0.0 - 0.4) and having been counselled for HIV testing during ANC (OR=0.1, 95% CI 0.0 - 0.4) were associated with likelihood of having a known HIV status. Out of the ten women with unknown HIV status, 4/6 who attended ANC in public/government accredited health facilities "opted out" of HIV testing due to personal reasons. Among the four who attended ANC in private clinics, two were not offered HIV testing and one "opted out".

CONCLUSION

Most participants had a known HIV status at labour (97%). Private clinics need to be supported to provide free quality HCT services in ANC.

Correlation between rapid HIV testing and fourth-generation ELISA results for HIV detection among pregnant patients in the delivery room

OBJECTIVE

To analyze the usefulness of rapid HIV testing in pregnant patients in the delivery room.

METHODS

This prospective study compared a rapid test and a fourth-generation enzyme-linked immunoassay (ELISA) for HIV screening among pregnant patients admitted in labor with an unknown HIV status at a university hospital in Mexico between July 2015 and February 2016. Pearson correlation analysis was performed, and the diagnostic accuracy of the two tests was assessed with HIV RNA polymerase chain reaction (PCR) as the reference method.

RESULTS

Overall, 534 patients were included. With a signal-to-cutoff (S/CO) value of 1.0 or more as a diagnostic criterion, 6 (1.1%) patients had a positive ELISA result. Three had a negative rapid test and three had a positive test (r=0.705). With an S/CO value of 2.0 or more as cutoff, 4 (0.7%) patients had a positive ELISA result. Three had a positive rapid test and one had a negative test (r=0.865). Only three of six patients with an S/CO of 1.0 or more were confirmed to have HIV by RNA PCR.

CONCLUSION

The rapid test showed a strong correlation with the fourth-generation ELISA. Therefore, rapid testing is a useful tool in the delivery room for patients with unknown HIV status.