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An Evaluation of Introduction of Rapid HIV Testing in a Perinatal Program

      Abstract

      Objective

      This study was conducted to evaluate the roll-out of rapid HIV testing as part of an emergency Prevention of Perinatal HIV Transmission Program. Specifically, HIV prevalence in this population, the reason(s) for performing the rapid HIV test, and compliance with recommendations for antiretroviral prophylaxis were assessed.

      Methods

      Since November 2011, all women presenting to a tertiary labour and delivery unit with unknown HIV status or with ongoing risk of HIV infection since their last HIV test were offered rapid HIV testing. Through retrospective chart review, demographic data, HIV risk and prior testing history, and antiretroviral prophylaxis, data were collected and descriptive statistics were performed.

      Results

      One hundred fourteen rapid HIV tests were conducted and there were two preliminary reactive rapid results (one true positive, one false positive). None of the infants was HIV infected. Sixty-three percent of women had multiple risk factors for HIV acquisition, most commonly intravenous drug use (54%). Forty-four percent of women were within the 4-week seroconversion window at the time of delivery; 25% of these women and 52% of their infants received prophylactic drug therapy.

      Conclusion

      Rapid HIV testing identified a high-risk cohort and enabled aggressive management of a newly diagnosed HIV-positive pregnancy, successfully preventing perinatal HIV transmission. Risk factors for HIV acquisition were ongoing within the seroconversion window for over half of the women, impacting the utility of the test in eliminating unnecessary antiretroviral prophylaxis in this population because prophylaxis is recommended despite a negative rapid HIV test in these cases.

      Résumé

      Objectif

      Cette étude avait pour but d'évaluer la mise en œuvre du dépistage rapide du VIH dans le cadre d'un programme de prévention d'urgence de la transmission périnatale du VIH. Elle portait plus particulièrement sur la prévalence du VIH au sein de cette population, les raisons motivant la tenue du test de dépistage rapide et l'observance des recommandations liées à la prophylaxie antirétrovirale.

      Méthodologie

      En novembre 2011, nous avons commencé à offrir le dépistage rapide du VIH aux femmes se présentant dans une unité de maternité de soins tertiaires avec un état sérologique vis-à-vis du VIH inconnu ou étant à risque d'avoir contracté le VIH depuis leur dernier dépistage. Nous avons recueilli des données et effectué des analyses statistiques descriptives au moyen d'un examen rétrospectif des dossiers médicaux ainsi que de l'étude des données démographiques, des risques d'infection au VIH et des antécédents de dépistage et de prophylaxie antirétrovirale.

      Résultats

      Au total, 114 tests de dépistage rapide du VIH ont été réalisés; deux des résultats préliminaires étaient positifs (un vrai et un faux positif). Aucun des bébés n'a été infecté par le virus. Soixante-trois pour cent des femmes de l'étude présentaient plusieurs facteurs de risque de contraction du VIH, le plus répandu étant la consommation de drogues injectables (54 %). Au moment de leur accouchement, 44 % des femmes se trouvaient dans la période de séroconversion de quatre semaines; 25 % de ces femmes et 52 % de leurs bébés ont reçu un traitement pharmacologique prophylactique.

      Conclusion

      Le dépistage rapide du VIH a permis de repérer une cohorte à risque élevé et de prendre vigoureusement en charge la grossesse d'une femme venant de recevoir un diagnostic de séropositivité, prévenant ainsi la transmission périnatale de l'infection. Chez plus de la moitié des femmes, les facteurs de risque de contraction du VIH étaient toujours présents pendant la période de séroconversion, ce qui diminue l'utilité du test de dépistage. Le test ne permettait donc pas d'éviter un traitement inutile à ces patientes, car un traitement antirétroviral prophylactique est recommandé en présence de facteurs de risque, même si le résultat du test est négatif.

      Key Words

      Abbreviations:

      BC (British Columbia), BCWH (BC Women's Hospital and Health Centre), cART (combination antiretroviral therapy), EIA (enzyme immunoassay), IVDU (intravenous drug use), LDR (labour and delivery), PCR (polymerase chain reaction test)
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