Is it Feasible to Use an Oral-Fluid Based Rapid Test Facilitated by Frontline Workers to Improve HIV Screening of Pregnant Women in Indian Rural Settings?

Abstract

Objectives: The importance of knowing HIV status is a key strategy for HIV response and effective treatment services. The present study aimed to assess feasibility of using oral- fluid based rapid HIV test aided by FrontlineHealth workers (FLWs) of pregnant women in rural districts of India. Methods: A feasibility study, using cross sectional design was carried-out in two rural districts of India. Overall, 900 pregnant women were screened using OraQuick® test, an oral-fluid based rapid HIV test facilitated by trained FLWs and subsequently, all participants were tested at in existing government center for confirmatory HIV testing. The data were collected from three aspects: i) the results of OraQuick® HIV test and confirmatory test ii) the perspectives of FLWs through in-depth interviews and iii) information on the acceptability of oral-fluid based HIV testing from 479 pregnant women, through a structured questionnaire. The descriptive statistics was used to analyse the quantitative data and thematic content analysis to analyse the qualitative in-depth interviews. Results: Of the 947 pregnant women who were offered HIV screening using OraQuick® saliva based test, 95% (n=900) accepted to undergo the test. Of the total 479 pregnant women interviewed, 91.2% liked the OraQuick® kit for HIV screening. The key motivators of accepting the test are easy procedure (43%), non-invasiveness (29%) and quick access to results (18%). Out of 900 pregnant women screened by OraQuick®, nine women were found to be HIV positive, which corresponded with confirmatory test results. Qualitative data provided insights into FLWs to understand their views regarding current situation on HIV testing and services available to the pregnant women. Conclusion: With an urgent need to improve access to HIV screening at the grass root level, an oral based HIV rapid testing mechanism can provide a plausible solution for improving early detection of HIV among pregnant women.