Preventing mother-to-child HIV transmission in low-income countries

Can HIV transmission in pregnancy in low income settings be prevented with round the clock rapid testing in labor?

The World Health Organization has reported that over 500,000 children under 15 years of age become infected with HIV every year, mainly through mother-to-child transmission during pregnancy, childbirth, and breastfeeding (MTCT). Transmission around the time of birth can be prevented with antiretroviral drugs and safer delivery and feeding practices. However, in many low-income settings a woman may have few opportunities for HIV testing before she goes into labor. Therefore, programs in which immediate HIV testing is made available within the context of the labor ward, together with counseling and treatment services, may help to reduce the extent of MTCT in developing countries.

In this issue of PLoS Medicine, Nitika Pant Pai and colleagues evaluated such a program, carried out in a rural hospital in Maharashtra State, India. The researchers found that most women presenting in labor did not already know their HIV status, but the overwhelming majority accepted HIV testing on the labor ward. As part of the program, women were enrolled, received counseling, their test results, and referral for treatment interventions (if appropriate) within 40-60 minutes. As a result of the program, 15 women (of 1,222 in total who received HIV testing) were found to be HIV infected, of whom 11 were newly diagnosed at the point of care. These results demonstrate the feasibility of introducing rapid, round-the-clock HIV testing within a labor ward in a low-income setting.

Future challenges involve establishing how these findings can be applied more widely in other low-income settings to upgrade and expand existing HIV testing services.

In an expert commentary on the new research, David Celentano (Bloomberg School of Public Health, Johns Hopkins University), who was not involved in the study, says: “It is clear that the labor and delivery setting offers the final opportunity to detect and prevent mother-to-child transmission of HIV. The program outlined by Pai and colleagues is efficient, acceptable, and leads to reduced morbidity.”

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