Rapid Human Immunodeficiency Virus Testing in Obstetric Outpatient Settings: The MIRIAD Study

Abstract

This investigation was conducted as part of the Mother-Infant Rapid Intervention at Delivery (MIRIAD) study, a prospective, multicenter trial assessing routine rapid human immunodeficiency virus (HIV) screening of pregnant women in inpatient and outpatient settings. This study compared rapid HIV testing with conventional HIV testing in outpatient obstetric settings among a population of pregnant women who presented late in care with undocumented HIV status. The investigators hypothesized that rapid testing would provide results faster than conventional testing in this setting and would also be acceptable and feasible. The study was carried out in 285 nonlaboring pregnant women volunteers at ≥ 34 weeks' gestation, who presented at hospital clinics in 6 US cities between 2002 and 2005. Median times between conventional and rapid testing and between rapid point-of-care and rapid laboratory-based testing were determined. More than 90% of eligible women who were approached agreed to participate. Results were available for rapid tests much sooner than for conventional tests: median time between blood draw and availability of results was 25 minutes (range, 20-110 minutes) among women with rapid HIV testing and 23 hours (range, 3.5 hours-43 days) among women with conventional testing (P < 0.0001). Most results for rapid testing (n = 273 or 96%) were available within 1 hour. Median test duration was shorter when the rapid tests were performed at the point-of-care (24 minutes) than when they were preformed in the laboratory (35 minutes) (P < 0.0001). These findings show that rapid testing for HIV provides results far sooner than conventional testing in the outpatient obstetric setting and is acceptable and feasible.