Is HIV Testing During Labor Feasible?

Eugene Kongnyuy of the Liverpool School of Tropical Medicine and his collaborators from the University of Yaounde I, Cameroon, investigated the acceptability of rapid HIV testing among 2413 women of unknown HIV status at four hospitals in the capital city, Yaounde. They found that 88.3% of the women were willing to accept HIV testing during labour. Furthermore, their study revealed a higher rate of HIV infection among women screened during labour (10.1%) than was previously estimated in a national health survey (6.8%) which, according to the authors, highlights the importance of HIV testing during labour.

About 3.2 million infants and young children worldwide are infected with HIV and in most cases the infection is a consequence of mother-to-child transmission (MTCT). Rapid HIV testing during labour or delivery represents the last opportunity for treatment before delivery to reduce MTCT. While this investigation has shown that HIV testing in the delivery room is feasible, it is nevertheless a challenging task especially in resource-constraint settings. The authors recommend "an opt-out approach for HIV testing during labour in Cameroon (i.e. women are informed that HIV testing will be routine during labour if HIV status is unknown but each person may decline to be tested). Such an approach will decrease the proportion of women who give birth with unknown HIV status and increase the number of mother-infant pairs who receive appropriate treatment for preventing MTCT of HIV".

The team propose that cost-effectiveness of HIV counselling and testing during labour is evaluated before the approach is implemented nationwide.