Pilot Study of Expedited HIV-1 Testing of Women in Labor at an Inner-City Hospital in New York City

ABSTRACT

To evaluate the feasibility of offering voluntary counseling and expedited human immunodeficiency virus (HIV) testing to women in labor, and to assess the characteristics of two rapid HIV assays compared with results from an expedited standard enzyme immunoassay (EIA), with Western blot confirmation, as indicated, we undertook a pilot study immediately prior to enactment of New York State regulations (August 1999) requiring expedited testing of laboring women (or newborns) with undocumented HIV status. From June 9, 1999 through July 2, 1999, we offered HIV counseling and testing (C&T) to all medically stable women in active labor, 106 of 125 (85%) of whom accepted. One woman was confirmed HIV-1 seropositive. Rapid assay sensitivity and specificity were: SUDS 100 and 98%, and Multispot 100 and 100%, respectively in comparison with 100 and 99% for the standard EIA. The positive predictive values (PPV) were SUDS 33%; Multispot 100%; and EIA 50%. While our sample size was small, it appears that the accuracy of rapid and expedited HIV assays may be improved by requiring two different reactive assays before informing women of HIV-seropositive results or initiating antiretroviral treatment.

@kw:KEYWORS: Congenital human immunodeficiency virus infection, newborn HIV testing, maternal-to-child transmission of HIV

REFERENCES

• 1 New York State Department of Health. Expedited HIV testing of women and newborns. L.D. No. HLT-51-98- 00007-P. NY State Register, May 19, 1999; pp. 19-21
• 2 Connor E M, Sperling R S, Gelber R. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with Zidovudine treatment.  N Engl J Med . 1994;  331 1173-1180
• 3 Centers for Disease Control and Prevention. U.S  Public Health Service recommendations for human immunodeficiency virus counseling and voluntary testing for pregnant women. Mortal Morbid Wkly Rep . 1995;  44(RR-7) 1-14
• 4 Birkhead G, DeBuono B A. HIV counseling and testing of pregnant women and newborns. Amendment of sections 98.2, 405.44, 751.5, 754.7, and 754.11 of Title 10 NYCRR Memorandum. Albany, NY: New York State Department of Health; 1996
• 5 New York State Department of Health. AIDS in New York State Albany, NY: New York Department of Health 1998
• 6 Shaffer N, Chuachoowong R, Mock P A. Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomized controlled trial.  Lancet . 1999;  353 773-780
• 7 Wade N A, Birkhead G S, Warren B L. Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus.  N Engl J Med . 1998;  339 1409-1414
• 8 Anderson S, Da Silva Z, Norrgren H, Dias F, Biberfeld G. Field evaluation of alternative testing strategies for diagnosis and differentiation of HIV-1 and HIV-2 infections in an HIV-1 and HIV-2 prevalent area.  AIDS . 1997;  11 1815-1822
• 9 Last J M. A Dictionary of Epidemiology.  New York: Oxford University; 1983
• 10 Stetler H C, Granade T C, Nunez C A. Field evaluation of rapid HIV serologic tests for screening and confirmating HIV-1 infection in Honduras.  AIDS . 1997;  11 369-375
• 11 Fonseca K, Anand C M. Predicting human immunodeficiency virus type-1 positive sera by using two enzyme immunoassay kits in a parallel testing format.  J Clin Microbiol . 1991;  29 2507-2512
• 12 Centers for Disease Control and Prevention. 1998 Guidelines for treatment of sexually transmitted diseases.  Mortal Morbid Wkly Rep . 1998;  47(RR-1) 35-36
• 13 Chirgwin K D, Feldman J, Dehovitz J A, Minkoff H, Landesman S H. Incidence and risk factors for heterosexually acquired HIV in an inner-city cohort of women: temporal association with pregnancy.  J Acquir Immune Defic Syndr Hum Retrovirol . 1999;  20 295-299