HIV This Week

Hillis SD, Rakhmanova A, Vinogradova E, Voronin E, Yakovlev A, Khaldeeva N, Akatova N, Samarskaya M, Volkova G, Kissin D, Jamieson DJ, Glynn MK, Robinson J, Miller WC. Rapid HIV testing, pregnancy, antiretroviral prophylaxis and infant abandonment in St Petersburg. Int J STD AIDS 2007;18:120-2.

In St Petersburg, Russia, a rapid HIV-testing programme was implemented in April 2004 for high-risk women giving birth. Among 670 women without prenatal care who received rapid HIV testing, 6.4% (43) had positive results. Among HIV-positive mothers, receipt of intrapartum antiretroviral prophylaxis increased significantly compared to pre-programme levels (76 versus 41%). Additionally, infant abandonment increased significantly (50% versus 26%), and was 10 times greater in women with unintended versus intended pregnancies (73% versus 7%).

Editors’ note : This study highlights the advantages and disadvantages of rapid HIV testing. Although knowledge of serostatus is required for uptake of antiretroviral prophylaxis to reduce mother-to-child transmission, the HIV testing process may not adequately prepare the pregnant mother to receive her HIV diagnosis and can lead to increased infant abandonment. Supportive counselling and services are critical to helping women understand their HIV diagnosis, the probability of transmission to their infant and future perspectives for themselves and their babies.

Magoni M, Okong P, Bassani L, Kituka Namaganda P, Onyango S, Giuliano M. Implementation of a programme for the prevention of mother-to-child transmission of HIV in a Ugandan hospital over five years: challenges, improvements and lessons learned. Int J STD AIDS 2007;18:109-13.

To identify factors that may limit acceptance of HIV testing and enrolment in the programmes for the prevention of mother-to-child-transmission of HIV, Magoin and colleauges retrospectively assessed the performance of the service at St Francis Hospital, Nsambya in Kampala. Over five years, a total of 26,556 pregnant women were offered voluntary counselling and confidential HIV testing and, if HIV positive, enrolment in the programme. Acceptance of the HIV test increased in the last two years (from 72.7% in 2001-2002 to 79.9% in 2003-2004). Enrolment in the programme increased over time and was greater among older (64% in women older than 30 years and 44.8% in those aged less than 20 years) and highly educated women. HIV prevalence was associated with age and inversely associated with the level of education. The need for specific personnel for counselling, male partners’ involvement and availability of antiretroviral drugs for those who needed treatment were identified as factors possibly affecting implementation.

Editors’ note : This one hospital has implemented and sustained a large prevention of mother-to-child transmission programme which demonstrates increasing acceptance of prenatal HIV testing over time. There is no doubt that the quality of counselling, the extent of male partners’ involvement and availability of treatment are important factors influencing women’s decisions to accept HIV testing during pregnancy.