HIV testing of pregnant women

While looking around over at PLoS One, I came across this study.

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 by Mkwanazi et al.

Personally, I found the title confusing, but what it tries to convey is the fact that the availability of rapid HIV testing has not led to more people wanting to get tested, contrary to what one might have believed.

Background

Rapid testing of pregnant women aims to increase uptake of HIV testing and results and thus optimize care. We report on the acceptability of HIV counselling and testing, and uptake of results, before and after the introduction of rapid testing in this area.

Methods and Principal Findings

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 (AOR 0.648, p<0.001), as were women aged 21–35 (AOR 0.762, p<0.001) and >35 years (AOR 0.756, p<0.01) compared to those >20 years.

Conclusions

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.

The study is interesting for several reasons. Not only did it find that rapid test results are not helping getting more women to get tested, it also shows that young women (below 21 years old) are more likely to get tested, and that educated women are less likely to get tested. Also, in the time period observed, there has been a general downward trend in getting tested.

All of this makes it sound like that targeted promotion of HIV tests to educated women and/or women above 20 could be at least as efficient as ensuring rapid test results.