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
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.