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Rapid HIV-1 Testing During Labor
A Multicenter Study
Marc Bulterys, MD, PhD;
Denise J. Jamieson, MD, MPH;
Mary Jo O'Sullivan, MD;
Mardge H. Cohen, MD;
Robert Maupin, MD;
Steven Nesheim, MD;
Mayris P. Webber, DrPH;
Russell Van Dyke, MD;
Jeffrey Wiener;
Bernard M. Branson, MD; for the Mother-Infant Rapid Intervention At Delivery (MIRIAD) Study Group
JAMA. 2004;292:219-223.
Context Timely testing of women in labor with undocumented human immunodeficiency virus (HIV) status could enable immediate provision of antiretroviral prophylaxis.
Objectives To determine the feasibility and acceptance of rapid HIV testing among women in labor and to assess rapid HIV assay performance.
Design, Setting, and Patients 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.
Main Outcome Measures 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.
Author Affiliations: Division of HIV/AIDS Prevention, Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Bulterys, Jamieson, and Branson and Mr Wiener); Department of Obstetrics and Gynecology, University of Miami School of Medicine, Miami, Fla (Dr O'Sullivan); Department of Medicine, Cook County Hospital, Chicago, Ill (Dr Cohen); Department of Obstetrics and Gynecology, Louisiana State University School of Medicine, New Orleans (Dr Maupin); Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga (Dr Nesheim); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (Dr Webber); and Department of Pediatrics, Tulane University School of Medicine, New Orleans, La (Dr Van Dyke).
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