[NEW DELHI] A study has shown that pregnant women can be rapidly tested for HIV in labour wards of rural hospitals — and antiretroviral therapy (ART) can be delivered effectively to prevent transmission of the virus to their children.
The research, published in PLoS Medicine, tested the feasibility of providing round-the-clock rapid HIV testing and counselling in labour wards in resource-poor settings.
In 2007, about 2.1 million children were infected with HIV, 85–90 per cent of whom contracted the infection from their mother.
The rapid tests helped doctors quickly decide on whether to start ART as a precautionary measure, before test results came in, usually one to three days after delivery.
Of 1,222 women admitted for delivery at a rural teaching hospital in Sevagram, western India, 15 were found to be HIV positive, 11 of whom did not previously know their status. Of those 15 women, 13 had children that tested negative for HIV.
The researchers used two different rapid tests, based on saliva and blood samples, which give results in 20 minutes.
They also carried out conventional HIV testing. If women tested positive in both the rapid tests and conventional tests, the scientists confirmed infection with a further test that detects HIV antibodies and gives results in two days.
"These findings are relevant to PMTCT [prevention of mother to child transmission] programmes in developing countries. Controlling HIV infection in women and children is crucial for changing the trajectory of the global HIV epidemic," the researchers write.
The rapid tests are awaiting approval in India. Nitika Pai, a postdoctoral fellow at the division of infectious diseases at Canada's McGill University, told SciDev.Net that it should be possible to train counsellors to run the tests and provide round-the-clock counselling at primary healthcare centres — often the first or only point of healthcare for pregnant women.
Only nine per cent of pregnant women currently receive ART, says Pai.
In many rural areas, women fear HIV testing due to social ostracisation. In addition, many women cannot access or afford antenatal care to receive preventative therapy. "The labor and delivery period is the last window of opportunity to prevent HIV transmission," says Pai.
"Without ART, the probability of transmission is 30–35 per cent; with ART it is reduced to 10–15 per cent," she says.
PLoS Medicine doi 10.1371/journal.pmed.0050092 (2008)