Comparison of Urine and Blood Testing for HIV among Pregnant Women in Calabar, Nigeria

Abstract

Testing for HIV is an essential component of the diagnosis and treatment of persons infected with the virus, and antenatal care provides a golden opportunity for detection of HIV infection in women of childbearing age. The use of blood sample to test for HIV has been the gold standard in clinical practice. However other body fluids such as urine, cervical secretion, tears, and saliva have potential as alternative media for HIV testing. This was a comparative noninferiority experimental study, comparing rapid diagnostic HIV testing using urine and blood samples. Two hundred and fifty new antenatal care clients and laboring women of unknown HIV status, were randomly recruited from antenatal care and delivery units. The seroprevalence of HIV was 6.31 and 5.86%, with use of urine and blood samples, respectively. The use of both urine and blood samples yielded a sensitivity of 100%. However, specificity was 99.05 and 99.52% for urine and blood samples, respectively. Area under receiver operating characteristic (ROC) curve was 0.995 and 0.998 for urine and blood samples, respectively. There was no significant difference in subjects’ perception toward the use of blood or urine for HIV testing (p > 0.05). More subjects however preferred the use of blood rather than urine for HIV testing. In keeping with previous studies, the use of urine or blood for HIV testing in this study yielded similar results, with comparable sensitivities and specificities. Urine samples may therefore well be considered as alternative to blood samples for HIV testing. The use of urine should be considered by health-care providers as suitable alternative to blood for HIV testing. Pregnant women should be educated on the benefits and accuracy of using urine for HIV testing, for improvement in the perception toward its usage and its acceptability and preference.