HIV This Week

Mkwanazi NB, Patel D, Newell ML, Rollins NC, Coutsoudis A, Coovadia HM, Bland RM. Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa. Rapid testing may not improve uptake of HIV testing and same day results in a rural South African community: a cohort study of 12,000 women. PLoS ONE. 2008;3(10):e3501.

Rapid testing of pregnant women aims to increase uptake of HIV testing and results and thus optimize care. Mkwanazi and colleagues report on the acceptability of HIV counselling and testing, and uptake of results, before and after the introduction of rapid testing in this area. HIV counsellors offered counselling and testing to women attending 8 antenatal clinics, prior to enrolment into a study examining infant feeding and postnatal HIV transmission. From August 2001 to April 2003, blood was sent for HIV ELISA testing in line with the Prevention of Mother-to-Child Transmission (PMTCT) programme in the district. From May 2003 to September 2004 women were offered a rapid HIV test as part of the PMTCT programme, but also continued to have ELISA testing for study purposes. Of 12,323 women counselled, 5,879 attended clinic prior to May 2003, and 6,444 after May 2003 when rapid testing was introduced; of whom 4,324 (74.6%) and 4,810 (74.6%) agreed to have an HIV test respectively. Of the 4,810 women who had a rapid HIV test, only 166 (3.4%) requested to receive their results on the same day as testing, the remainder opted to return for results at a later appointment. Women with secondary school education were less likely to agree to testing than those with no education (adjusted odds ratio 0.648, p<0.001), as were women aged 21-35 (adjusted odds ratio 0.762, p<0.001) and >35 years (adjusted odds ratio 0.756, p<0.01) compared to those <20 years. Contrary to other reports, few women who had rapid tests accepted their HIV results the same day. Finding strategies to increase the proportion of pregnant women knowing their HIV results is critical so that appropriate care can be given.

Editors’ note: Rapid HIV testing avoids transportation of samples to laboratories and ensures that women presenting late in pregnancy can receive their results prior to labour and delivery. This study of rapid testing among pregnant women attending clinics that offered HIV testing from 2001 as part of a postnatal transmission study, found little interest in the same-day result that rapid testing allows. Rapid testing had no effect on the proportion of women agreeing to have an HIV test (about 75%). This could be due to women wanting time to consider their personal risks and support networks before accepting results. It is important to respect pregnant women’s abilities and readiness to receive HIV test results. Community mobilisation for stigma reduction and serostatus knowledge may work better than a technological advancement to increase the proportion of women who know their HIV status in pregnancy. Only then will the current unacceptable rates of mother-to-child transmission decrease and will more eligible women get on antiretroviral drugs for their own health.