AEGiS-13IAC: Impact of on-site HIV rapid testing with sam-day post-test counseling on acceptance of short-couse zidovudine for the prevention of mother-to-child transmission of HIV in Abidjan, Cote d'Ivoire.

13th International AIDS Conference

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

Impact of on-site HIV rapid testing with sam-day post-test counseling on acceptance of short-couse zidovudine for the prevention of mother-to-child transmission of HIV in Abidjan, Cote d'Ivoire.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. WeOrC549)

Sibailly TS, Ekpini ER, Kamelan-Tanoh A, Yavo D, Maurice C, Nkengasong J, Roels TH, Wiktor SZ, Chorba TL
T.S. Sibailly, Projet Retro-CI, CDC/HIV c/o US Embassy, 5, rue Jesse Owens 01 BP 1712, Abidjan 01, Cote D'Ivoire, Tel.: +225 2125 4111, Fax: +225 2124 2969, E-mail: tbs2@cdc.gov

BACKGROUND: Short course oral zidovudine (ZDV) administered in late pregnancy prevents mother-to-child transmission of HIV. However, due to poor acceptance of HIV testing including post-test counseling (PTC), most HIV-infected women do not benefit from this intervention in Abidjan.

OBJECTIVE: To assess the impact of HIV rapid testing with same-day PTC on acceptance of short-course ZDV in Abidjan.

METHODS: All women attending a large public antenatal clinic receive group HIV counseling and individual consent for HIV testing, and if HIV-1 seropositive, short-course ZDV at 36 weeks gestation. From February 1998 to May 1999, HIV testing was conducted at a research laboratory using an EIA-based algorithm with PTC occurring 2 weeks later. In May 1999, on-site HIV testing using a rapid-test algorithm was initiated with same-day PTC.

RESULTS: During use of the EIA algorithm, 9,652 women visited the clinic, of whom 6,976 (72.3%) accepted HIV testing; 925 (13.3%) were identified as HIV-1 or HIV-1/2 dually reactive (HIV-D), of whom 503 (54.4%) did not return for PTC. 267 (28.8%) returned for PTC but were lost to follow-up before 36 weeks gestation, 19 (2%) refused ZDV, 19 (2%) delivered before 36 weeks, and 117 (12.6%) received ZDV. Using rapid testing with same-day PTC, 3,942 women were seen, of whom 2,701 (68.5%) consented to testing; 294 (10.9%) were HIV-1 or HIV-D, of whom 69 (23.5%) left the clinic prior to PTC; 154 (52.4%) received PTC but were lost to follow-up before 36 weeks gestation, 28 (9.5%) have gestational age > 36 weeks, 6 (2%) delivered before 36 weeks, and 37 (12.6%) received ZDV.

CONCLUSION: Although the proportion of pregnant women who receive an HIV test result is higher with on-site HIV rapid testing and same-day PTC than with separate-visit PTC, the proportion of women receiving ZDV remains low due to high loss-to-follow-up prior to 36 weeks gestation. Alternative strategies for HIV testing are needed as is a better understanding of the reasons behind poor adherence to prenatal visits.

Keywords: AEGIS, Zidovudine, HIV Infections, Counseling, HIV-1, HIV Seropositivity, Mothers, Research Design, S-Adenosylmethionine, Time, Cote d'Ivoire, Child, Human, Female, Pregnancy, transmission, prevention & control
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WeOrC549