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Background: In the United States 6-7000 women infected with HIV give birth every year. Although routine prenatal care includes HIV testing, 5% of women do not receive prenatal care and should have rapid HIV testing at the time of delivery because anti-retroviral chemoprophylaxis during labor or within 12 hours of birth reduces maternal-fetal HIV transmission from 25% to 9-13%. The OraQuick rapid HIV test has a reported 99.6% sensitivity and 100% specificity, however multiparous women can have false positive results.
Purpose: To examine the risks and benefits of the OraQuick rapid HIV test in pregnant multiparous women.
Methods: Data were obtained from searching Medline, CDC, National Vital Statistics Reports, the Cochrane Library and the Red Book to determine national data regarding annual pregnancies, absence of prenatal care, multiparity, HIV prevalence in women of child-bearing age, efficacy of chemoprophylaxis and cost of medications. OraQuick test characteristics (sensitivity 99.6% and specificity 93.3%) were based on FDA data.
Results: In the US in 2002, 39,107 women received no prenatal care, and in an urban setting, 85.3% of pregnant women not receiving prenatal care were multiparous. The CDC reported HIV prevalence in women of childbearing age varies from 0.8% to 4.0%. For this prevalence range, of 33,103 multiparous women not receiving prenatal care, 267-1,335 women will be HIV-positive. OraQuick would identify 266-1329 of those HIV-infected, but also 2,136-2,207 uninfected would be false positives. Assuming a 25% maternal-fetal HIV transmission rate and that antiretroviral therapy reduces transmission by one-half, treating all OraQuick positive individuals lowers HIV transmission from 66 to 33 and 332 to 166 respectively. However, by treating all who test positive, 21 to 74 women would need to be treated with antiretroviral therapy to prevent one case of HIV transmission (NNT). Furthermore, 1.7 to 8 women without HIV would be treated for every women appropriately treated. Cost of $132 (ZDV = $41.15, OraQuick =$39, Western Blot = $52) per positive test for a total of $317,064-$466,752 or $2,811-9,608 per maternal-fetal HIV transmission prevented. One to six HIV-infected mothers would miss an opportunity to receive chemoprophylaxis.
Conclusions: In multiparous women, the OraQuick Rapid HIV test has decreased specificity, so some women without HIV would likely be treated to prevent maternal-fetal HIV transmission. Local seroprevalence data should be obtained.
See more of Poster Session - Public Health; Methodological Advances
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)