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Rapid HIV Testing and Prevention of Mother-to-Child HIV Transmission in High-risk Maternity Hospitals, St Petersburg, Russia, 2004-2005
Dmitry Kissin*1, N Akatova2, A Rakhmanova3, E Vinogradova4, E Voronin5, D Jamieson1, M Glynn1, J Robinson6, W Miller7, S Hillis1, and PMTCT in High-Risk Women Project Team
1CDC, Atlanta, GA, US; 2Glaser Pediatric AIDS Fndn Implementation Grant, St Petersburg, Russia; 3City Hlth Comm, St Petersburg, Russia; 4City AIDS Ctr, St Petersburg, Russia; 5Republican Hosp of Infectious Diseases, St Petersburg, Russia; 6Glaser Pediatric AIDS Fndn, Santa Monica, CA, US; and 7Univ of North Carolina at Chapel Hill, US
Background: The spread of the
HIV epidemic into the general population makes prevention of mother-to-child
HIV transmission (PMTCT) a top priority in Russia.
Methods: From April 13, 2004
to April 13, 2005, eligible women presenting in active labor at 2 high-risk
maternity hospitals in St. Petersburg,
were offered point-of-care rapid HIV testing (RT) using Determine (Abbott
Laboratories) and parallel enzyme immunoassay (EIA) testing with Western blot confirmation.
Criteria for RT included no documented HIV test ≥34 weeks gestation or active
injection drug use. We evaluated performance of RT and PMTCT program and
assessed selected reproductive health indicators for HIV-infected mothers.
Results: Of the 8790 women
giving birth, 4400 (50.1%) were eligible for RT. Of these, 3707 (84.3%)
underwent RT. RT results were available to labor and delivery staff for 3349
(90.3%) of women tested. RT results were unavailable until after delivery for
50.2% of women presenting <1 hour before delivery, compared with 0.6% of
women presenting earlier. The median time between blood collection and
availability of RT results was 20 minutes. Among women tested, 6.6% (90 of 1375)
of those with no previous HIV tests, 0.6% (9 of 1571) of those with 1 negative
HIV test, and 0.1% (1 of 725) of those with 2 such tests, had positive RT
results. All Western blot tests performed on positive RT specimens were either
positive (96.7%) or indeterminate (3.3%), but were unavailable until after
discharge for 91.1% of women. Among 101 women with positive RT, 76.2% received ART
prophylaxis, and 97.9% (93/95) of their infants received ART prophylaxis and replacement
feeding. Of the 58 infants with follow-up HIV testing data, 5 (8.6%) met
criteria for definitive or presumptive HIV infection. Both unintended pregnancy
(65.3%) and infant abandonment (40.0%) were commonly reported among
HIV-infected mothers.
Conclusions: The use of RT achieves
timely detection of HIV-infected women presenting in labor with undocumented
HIV status, and facilitates appropriate delivery of intrapartum ART prophylaxis
to these women and their infants. The success of PMTCT program could be
improved by: strengthening programs
emphasizing the importance of early presentation for labor and delivery;
identifying timely and efficient confirmatory algorithm for RT; improving follow-up
for perinatally exposed infants; strengthening prevention of unintended
pregnancy in HIV-infected women; and intensifying interventions to prevent
infant abandonment.
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