AEGiS-13IAC: Intrapartum rapid HIV testing and intervention among women without adequate prenatal care: The Mother-Infant Rapid Intervention at Delivery (MIRIAD) study in five US metropolitan areas.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Intrapartum rapid HIV testing and intervention among women without adequate prenatal care: The Mother-Infant Rapid Intervention at Delivery (MIRIAD) study in five US metropolitan areas.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrC243)

Bulterys M, Cohen M, Maupin R, Nesheim S, O'Sullivan MJ, Webber M, Lampe M, Fowler MG
M. Bulterys, Centers for Disease Control & Prevention, 1600 Clifton Road, Mailstop E-45, Atlanta, GA 30333, United States, Tel.: +1 404 639 49 80, Fax: +1 404 639 61 27, E-mail: zbe2@cdc.gov

ISSUES: Most HIV-infected pregnant women in the United States (US) use hospitals for delivery, providing a crucial opportunity for systematic screening and intervention when indicated. In some parts of the US, more infants might be spared HIV infection if the benefits of intrapartum/neonatal antiretroviral therapy (ART) were extended to pregnant women with little or no prenatal care than if transmission rates were further reduced among women already receiving adequate prenatal care.

DESCRIPTION: The CDC-funded MIRIAD Study in 5 US metropolitan areas (Atlanta, Chicago, Miami, New Orleans and New York City) will assess 1) innovative approaches to a 24-hour counseling and voluntary rapid HIV testing program among women in labor presenting with unknown HIV status; 2) the feasibility of obtaining informed consent during labor or soon after birth; 3) barriers to prenatal care and to HIV testing; 4) rapid ART given at labor and delivery or to the neonate; 5) adherence to neonatal therapy; and 6) subsequent receipt of ART and other services, as indicated, for women and their children. Overall HIV-1 seroprevalence among pregnant women at MIRIAD-participating hospitals ranges from 0.8% to 4%. After the study protocol is completed in April 2000, MIRIAD aims to offer voluntary rapid HIV testing, and ART if indicated, annually to between 6000 and 8000 pregnant women with unknown HIV status late in pregnancy. The question of how best to provide rapid HIV testing, to perform urgent confirmatory testing in this setting, and how best to present women with risk/benefit information and treatment options will be investigated.

CONCLUSIONS: In the absence of adequate prenatal care, rapid testing for HIV during the peripartum period has the potential to improve clinical outcomes for both women and their infants. Lessons learnt in MIRIAD will assist in formulating best-practice recommendations in the US for women presenting late in pregnancy. MIRIAD may also serve to improve knowledge about same-day testing options and start of ART relevant to high-risk perinatal populations elsewhere in the world.

Keywords: AEGIS, Prenatal Care, Delivery, Obstetric, HIV Infections, Mothers, HIV-1, Labor, Obstetric, Research Design, HIV Seropositivity, Counseling, Voluntary Programs, United States, Mass Screening, Seroepidemiologic Studies, Chicago, New York City, Infant, Human, Adult, Female, Pregnancy, Child, nursing, surgery
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MoOrC243