The role of the rapid HIV test in women with no prenatal care

Abstract

The purpose of this study was to evaluate the cost effectiveness of rapid HIV screening tests in laboring women presenting with no prenatal care. Ninety-seven charts were reviewed of women with no prenatal care presenting in active labor at our institution from December, 1996 to April, 1998. All of these women had an HIV test drawn as part of the prenatal tests ordered upon admission. The cost of employing the rapid HIV screening test in these women was calculated using: 1. The prevalence of HIV in this population; 2. The false positive rate of the test; 3. The cost of the test; and 4. The cost of treating women with iv Zidovudine for an average of 5 hrs intrapartum at our institution. The background HIV seroprevalence for Norfolk, VA is 0.17%. None of the 97 women presenting in active labor with no prenatal care were found to be HIV positive. The cost of screening these women with the rapid HIV screen would have been $970.00 ($10.00/kit) compared to $388.00 using the ELISA ($4.00/kit). In addition, the CDC found the rapid screen to have a higher false positive rate in populations with a low HIV prevalence rate. Based on the seroprevalence rate among childbearing women in Norfolk, VA, the positive predictive value of the screen in our population, the cost of iv Zidovudine for 5 hrs intrapartum at our institution, and the cost of the screen, it will cost at least $6,450.00 to treat each pregnant woman infected with HIV detected with the SUDS rapid screen. The HIV prevalence rate in this high-risk population was very low (0%). Based on these data, the HIV rapid screening test would not have been cost effective in this population. In addition to the monetary costs of employing this screening test, other issues such as a significant number of patients receiving false positive results and unnecessary exposure to Zidovudine must be considered.