Rapid testing at labour and delivery to prevent mother-to-child HIV transmission in developing settings: issues and challenges.

Rapid testing at labour and delivery to prevent mother-to-child HIV transmission in developing settings: issues and challenges.

Worldwide, approximately 2.5 million children (95% CI: 2.2-2.6) are living with HIV infection. In 2007 alone, approximately 420,000 children (95%CI:350,000-540,000) were newly infected with HIV - a vast majority of these infections were acquired through maternal-foetal transmission. Many of these infections could have been reduced by timely diagnosis and the delivery of interventions aimed at preventing mother-to-child HIV transmission. This perspective examines the attitudes preventing women from accessing HIV testing early on during pregnancy and the issues and challenges that remain in the institutionalization of interventions to prevent mother-to-child HIV transmission at labour and delivery. Socio-cultural and economic factors prevent women from accessing testing at an opportune time during pregnancy. In addition, a lack of adequate infrastructure often prevents timely delivery of interventions to those who access testing at the last minute (i.e., during labour and delivery). In the wake of a paediatric HIV epidemic and the need for lifelong provision of antiretroviral therapy to infected children, a simple strategy for provision of round-the-clock rapid testing and counselling services in the labour rooms may be cost saving to the healthcare systems worldwide.

Editors’ note: Although studies of programmes of point-of-care rapid HIV testing in labour and delivery have been conducted around the world, the need for additional infrastructure resources, such as round-the-clock counsellors and user friendly and accurate rapid tests, has been an impediment to wider implementation. With only 33% of women needing antiretroviral prophylaxis in pregnancy worldwide actually able to access it, innovations are needed to improve coverage. Labour and delivery are not times conducive to reflection on the personal advantages and disadvantages of knowledge of serostatus but two-stage counselling (short prepartum and extended postpartum), attention to privacy and confidentiality, timely confirmation of results to reduce false-positives and false-negatives, and community-based education engaging partners and highlighting the importance of preventing HIV transmission to infants could identify more babies in need of intrapartum and post-exposure prophylaxis and more mothers needing tailored infant feeding counselling in addition to evaluation for antiretroviral treatment, and care and support.