Effective Point-of-Care Rapid Hiv
Testing at Labor and Delivery
CORE Ctr, Chicago, IL and CDC, Atlanta, GA

Although all women should be
screened for HIV during the antenatal
period, an estimated 10%-15% of HIV infected
mothers do not access care
before labor and delivery (L&D).
Point-of-care rapid HIV testing in obstetric
units could help L&D staff identify
and offer prophylactic treatment to
HIV-infected women in time to reduce
perinatal HIV transmission.
Four (4) Chicago hospitals participating
in the CDC multi-city Mother
Infant Rapid Intervention at Delivery
(MIRIAD) study implemented the
rapid testing protocol. Trained obstetric
staff performed rapid testing themselves
on the L&D unit in 3 hospitals.
In the 4th hospital, the rapid test was
run in the laboratory. After determining
eligibility and obtaining informed
consent, blood was drawn for the
Oraquick rapid HIV test and confirmatory
standard testing. We also determined
the median time from drawing
of the participant's blood to informing
her of her test results at each hospital.
Point-of-care rapid HIV
testing by staff attending
women in labor provides a
more timely method to
identify and treat women
with HIV
From November 2001-July 2002,
6,262 women presented to the 4 Chicago
obstetric units and 610 were eligible
for rapid testing (>24 weeks pregnant
and no documented HIV results
available to L&D staff). Of these, 453
consented to participate and were
tested with OraQuick. Three (3) previously
undetected HIV-infected
women were identified and started on
antiretroviral prophylaxis. in the 3
hospitals where nurses, midwives, or
physicians performed the rapid test at
point-of-care), median turn around
time was 45 minutes (range 20 mins to
3 hrs). At the hospital where the laboratory
performed the rapid test, median
turn around time was 3 hrs (range
90 mins to patient never informed of
result.) Delays in delivering rapid test
results were due to shift change in the
laboratory, staff not calling for the result
after the test was sent to the laboratory,
patient sleeping, or patient having
left the unit before test results were
returned.

Point-of-Care rapid HIV testing
by staff attending women in labor provides a more timely method to identify and treat women with HIV

who had not been tested during their
pregnancy than does conducting the
rapid HIV tests in the hospital laboratory.
L&D staff can be trained to perform
onsite rapid testing and then offer
peripartum anitretroviral prophylaxis
that can further reduce perinatal
HIV transmission in the U.S.