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)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
February 15,
2017
Received:
November 30,
2016
Footnotes
Competing interests: None declared.
Identification
Copyright
© 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
