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I.
Background on Rapid Testing during Labor and Delivery
Tremendous medical and public health achievements have been made
in the prevention of mother-to-child transmission (MTCT) of HIV-1.
The risk for infant infection has been reduced from approximately
25% to less than 2% by the use of currently recommended prenatal
ARV and obstetric interventions for a woman who is aware of her
HIV infection early in pregnancy.
Ideally,
all women should be screened for HIV before delivery, during
an initial prenatal care visit so that potent combination
antiretroviral treatment can be given to women who are HIV-infected.
However, according to the CDC, approximately 40% of the mothers
of the estimated 280–370 HIV-infected infants born
in 2000 were not known to have HIV infection before delivery.1
It is critical to greatly reduce these missed opportunities
for identifying HIV-infected pregnant women during the prenatal
period, when the most effective interventions can be delivered.
According to clinical trial data, ARV prophylaxis,
even when begun during labor and delivery and then given
to the
neonate,
can reduce MTCT of HIV as much as 50%.2-6To maximize
this benefit, it is of utmost importance to obtain HIV test
results
for women in labor as soon as possible. Timely rapid HIV
test results may allow providers to avoid some common obstetric
practices that may increase the risk of transmission (e.g.,
artificial rupture of membranes, amniocentesis, or sampling
of blood from the fetus’s scalp), and they can also
advise the mother not to breastfeed.7
Routinely offering rapid HIV testing to women
whose HIV status is unknown during labor and delivery provides
the
opportunity
to reduce transmission even among women who do not seek care
until labor begins. The rapid HIV test kits now licensed in
the United States allow test results to be available in 20
minutes or less. Results from the OraQuick Rapid HIV-1 Antibody
Test (OraSure Technologies, Inc., Bethlehem, Pennsylvania)
can be read within 20–40 minutes, and results from the
Reveal Rapid HIV-1 Antibody Test (MedMira Laboratories, Inc.,
Halifax, Nova Scotia) can be read in approximately 5–10
minutes after test procedures are begun. Findings from the
CDC-sponsored Mother-Infant Rapid Intervention at Delivery
(MIRIAD) study indicate that offering voluntary HIV testing
during labor is feasible in obstetric settings and that the
OraQuick Rapid HIV-1 Antibody Test, used on whole blood specimens,
delivers accurate and timely test results.8
The purpose of this document is to offer guidance
and practical tips to clinicians, laboratorians, hospital
administrators,
and policymakers who are planning and implementing a program
for HIV rapid testing during labor and delivery for women of
unknown HIV status and to provide the general structure of
a model rapid HIV testing protocol that can be adapted by staff
at facilities that seek to implement rapid testing during labor
and delivery. For additional background on perinatal HIV prevention,
see References, Other Suggested Reading, and Resources.
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