Can a routine peri-partum HIV counselling and testing service for women improve access to HIV prevention, early testing and treatment of children?
Context Prevention of mother to child transmission (PMTCT) of HIV relies on identification of HIV-positive pregnant women at the first antenatal visit and at time points thereafter. As not all women who attend antenatal care initially agree to test or maintain an HIV-negative status the lack of re-establishing HIV prevalence at delivery may result in missed prevention opportunities and a false impression of PMTCT coverage. Objectives To assess whether a routine peri-partum HIV counseling and testing service improves access to HIV prevention, testing and care of infants by identifying additional HIV-positive women at the time of delivery. To assess the effect on the PMTCT coverage indicator when HIV prevalence is reestablished in the delivery population. Design and Patients All women 18 years or older with live births in the labour and postnatal wards of the Rahima Moosa Mother and Child Hospital (RMMCH) were interviewed and invited to enrol irrespective of their need to retest/test for HIV or their potential refusal of an HIV test. Rapid HIV antibody tests were offered to women who had no HIV result, reported an HIV-negative result performed more than six weeks prior to delivery or reported an HIV result discrepant with her documented result. vi Test acceptance and HIV prevalence were calculated for the enrolled population. The rate of return and results for early infant diagnosis in HIV-exposed infants and the follow-up of infected infants were documented. HIV polymerase chain reaction (PCR) results for infants not returning to the facility were retrieved from the National Health Laboratory Services database. Results Between 9th April 2008 and the 23rd of September 2008 there were 5169 women with live births. A total of 3684 (71.3%) of the 5169 women delivering were interviewed and 2419 (46.8%) were enrolled. Of the women enrolled, 2140 (88.5%) reported a known HIV status and 490 (22.9%) of these were HIV-positive. After counseling and testing, an additional 101 HIV-positive women were identified increasing the number of HIV-positive women by 20.6%. An additional 177 women were identified as being HIV-negative. The true infant PMTCT coverage increased by 17% as a result of newly identified HIV-positive women. Of 591 HIV-exposed infants identified, 284 (48.0%) underwent PCR testing at RMMCH or surrounding facilities and 16 (5.6%) tested PCR-positive. Of the infants expected to return to RMMCH for PCR testing 155/203 (76.4%) antenataly diagnosed versus 12/83 (14.5%) newly diagnosed women returned with their infants (p<0.001). Ten HIVinfected infants were diagnosed at RMMCH of which nine were in care with six initiated on antiretrovirals.
MSc (Med), Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, 2009
HIV , counselling , testing , prevention , pregnant women