Research
Obstetrics
Rapid HIV testing and prevention of perinatal HIV transmission in high-risk maternity hospitals in St. Petersburg, Russia

Presented, in part, at the 13th Conference on Retroviruses and Opportunistic Infections, Denver, CO, Feb. 5-8, 2006.
https://doi.org/10.1016/j.ajog.2007.09.005Get rights and content

Objective

The purpose of this study was to evaluate the effectiveness of a human immunodeficiency virus (HIV) rapid testing (RT) program.

Study Design

From April 13, 2004, to April 13, 2005, pregnant women at 2 high-risk maternity hospitals with no or incomplete HIV testing results (negative tests at <34 weeks, none thereafter) were offered point-of-care RT, with antiretroviral prophylaxis for RT-positive women and their infants.

Results

Overall, 89.2% of eligible women (3671/4117) underwent RT, of whom 90.4% received results before delivery. HIV seroprevalence among all women who underwent RT was 2.7% (100/3671 women); among previously untested women, seroprevalence was 6.5% (90/1375 women); the incidence of HIV seroconversion among women with previous negative tests during pregnancy was 0.4% (10/2296 women). After adjustment, the main predictor of receiving RT results after delivery was late admission. Among HIV-exposed infants, 97.9% (92/94) received prophylaxis; 61.7% (58/94) had available follow-up data, and 8.6% (5/58) met criteria for definitive or presumptive HIV infection.

Conclusion

The RT program achieved timely detection of HIV-infected women in labor with unknown HIV status and effectively prevented perinatal HIV transmission.

Section snippets

Material and Methods

The Russian Ministry of Health recommends HIV testing twice during pregnancy: at the first prenatal care visit and after 34 weeks of gestation.11 RT with parallel standard HIV testing (enzyme immunoassay [EIA] with Western blot confirmation) is recommended for women at delivery without a documented record of an HIV test that was performed after 34 weeks of gestation, which is a group that includes women who had (1) no HIV tests during pregnancy or (2) negative HIV tests <34 weeks of pregnancy

Results

During the study period, 8790 women delivered in the 2 high-risk maternity hospitals, of whom 4162 women (47.4%) were eligible for RT (Figure). Of those, 4117 women were eligible because they had no HIV tests during pregnancy (1402 women; 33.7%) or had incomplete HIV testing (2715 women; 65.2%); 45 women who were eligible for other reasons were excluded. Among eligible women who had no HIV tests during pregnancy, 1375 women (98.1%) underwent RT; this compares with 2296 of the eligible women

Comment

RT provided timely detection of HIV-infected women in labor with previously undocumented HIV status and facilitated appropriate delivery of intrapartum antiretroviral prophylaxis to these women and their infants and avoidance of breastfeeding. Overall, 89% of eligible women were tested with RT, >90% of the women who were tested received the results before delivery; 76% of RT-positive women received antiretroviral prophylaxis, and 98% of perinatally exposed infants received antiretroviral

Acknowledgment

We thank the following individuals for their substantive contributions to the study: Tatyana Antoshina, Tatyana Bludova, Bernard Branson, Marc Bulterys, Galia Denisheva, Elena Gurvich, Natalia Khaldeeva, Evgenia Khrustaleva, Ekaterina Lazareva, Zoya Lisitsina, Tatyana Lyubimova, Nikolai Nefedov, Robin Ryder, Mida Samarskaya, Andrey Shved, Elena Sokolova, Elena Stepanova, Olga Talantova, Galina Volkova, Tatyana Vorobyova, and Cathy Wilfert.

References (22)

  • Rapid HIV antibody testing during labor and delivery for women of unknown HIV status: a practical guide and model protocol

    (2004)

    • Cited by (22)

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      During periods with a high uptake of VCT, seroprevalence was similar (13% vs 14%), whereas it was significantly higher among women who underwent VCT (17% vs 8%) when uptake was less than 70%. Other studies investigating intrapartum HIV testing for women entering labor with unknown HIV status did not report the HIV prevalence among women declining VCT [8–13]. The rate of acceptance ranged from 69% to 90% in these studies [8–11].

    • Rapid Diagnostic Methods in Sexually Transmitted Infections

      2008, Infectious Disease Clinics of North America
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      This study, like MIRIAD, demonstrated that POC HIV testing can be implemented in a labor and delivery unit. Kissin and colleagues [42] also demonstrated that implementing the program in their hospital increased the number of HIV-infected patients receiving prophylaxis during labor from 41% to 76%. Further studies are needed to determine if this results in a reduction in perinatal transmission.

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    • Incident HIV infection and perinatal transmission rates among HIV negative pregnant women who retested in labor in a tertiary health centre, South East Nigeria

      2019, Nigerian Journal of Clinical Practice

    • Evaluation of antenatal rapid human immunodeficiency virus testing in rural South Africa

      2018, Southern African Journal of HIV Medicine

    • New diagnoses of human immunodeficiency virus infection in the Spanish pediatric HIV Cohort (CoRISpe) from 2004 to 2013

      2017, Medicine (United States)
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    Supported by the United States Agency for International Development (Moscow) and the Elizabeth Glaser Pediatric AIDS Foundation.

    Cite this article as: Kissin DM, Akatova N, Rakhmanova AG, et al. Rapid HIV testing and prevention of perinatal HIV transmission in high-risk maternity hospitals in St. Petersburg, Russia. Am J Obstet Gynecol 2008;198:183.e1-183.e7.

    Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent views of the Centers for Disease Control and Prevention. Use of trade names is for identification purposes only and does not constitute endorsement by the Centers for Disease Control and Prevention or the Department of Health and Human Services.

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