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Attitudes toward rapid HIV testing during labour

In Canada and other high-income countries researchers estimate that a sizeable fraction of HIV-positive people (about 25% in Canada, according to the Public Health Agency of Canada) are not aware of their infection status. If the spread of HIV is to be reduced and the benefits of ART brought to more people, health authorities need to place more emphasis on reducing barriers to the offer of an HIV test accompanied by counselling and swift referral to care and treatment.

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As mentioned earlier in this issue of TreatmentUpdate, HIV testing, counselling and the use of potent combination therapy (commonly called ART or HAART), along with other measures, can improve an HIV-positive mother’s health and greatly reduce the risk that she will give birth to a baby with HIV.

However, for an HIV-positive mother and her fetus to benefit from ART, she must first know her HIV status. Hospitals have encountered visits from women very late in pregnancy or who were in labour and who had no idea of their HIV status. In such cases, HIV testing must be done with rapid testing to help doctors decide if measures are necessary to protect the fetus during and after the birthing process.

In the summer of 2011, as part of a study, researchers at St. Michael’s Hospital in Toronto surveyed 152 pregnant women about the acceptability and attitudes that they have toward receiving the possibility of an HIV testing during labour. The researchers reported that nearly 60% of women would accept such testing. If the test came back positive, 94% of women would accept taking ART and would use formula to feed their infants (HIV can be spread via breast milk).

Results

A total of 92 women completed the questionnaires. They were an average of 30 years old, most had more than a high school education and, according to the researchers, “all were HIV-negative.”

In total, 80% of the women disclosed that they had previously been tested for HIV (and were negative). Seventy-one percent of the women “were aware of having been tested [for HIV] during their current pregnancy.”

The main reasons that some women gave for refusing a potential HIV test included the following:

  • 39% did not want to know their test result
  • 29% felt that they would be in too much pain during labour

The researchers found that barriers to HIV testing centred around the following concerns raised by the women:

  • disapproval of their HIV status in the community
  • a negative reaction from their partner to a possible positive test result

Women who stated that they were not likely to consent to HIV testing had the following concerns:

  • they wanted to “know more of the benefits of early [HIV] diagnosis”
  • they wanted to know how long they had to wait for the test result
  • they were concerned about the testing process
  • they were concerned about the confidentiality of the test result

Women who were willing to undergo HIV testing compared to women who did not wish to undergo such testing were significantly more interested in the following:

  • learning about HIV treatment options
  • learning about access to health services
  • getting help and advice for how to tell a partner about a possible positive HIV test result

The researchers asked women about issues that would make the offer of an HIV test more acceptable and some of their responses were as follows:

  • if information was made available about the testing process
  • if they received individualized counselling
  • if they could participate in a discussion to learn more about how to prevent mother-to-child transmission of HIV

The majority of women said that they would like to discuss the test results with a doctor, preferably in a setting that offered privacy.

The study’s findings underscore the type of information and counselling that would make pregnant women comfortable when the offer of an HIV test is made.

Bear in mind

As the researchers asked women for their responses to the idea of an HIV test, they are not certain how these women might respond to the offer of an actual test during labour.

The researchers admit that their study “did not include many women who would be considered high risk for HIV such as [those who use street drugs, sex trade workers] and refugees from [regions where HIV is relatively common].”

The findings from the present study are useful because they can be used, together with the help of pregnant women, to develop sensitive HIV testing programs for this population.

—Sean R. Hosein

REFERENCE:

Iqbal S, De Souza LR, Yudin MH. Acceptability, predictors and attitudes of Canadian women in labour toward point-of-care HIV testing at a single labour and delivery unit. Canadian Journal of Infectious Diseases & Medical Microbiology. 2014 Jul;25(4):201-6.