Bulterys Marc, Jamieson Denise J, O'Sullivan Mary Jo, Cohen Mardge H, Maupin Robert, Nesheim Steven, Webber Mayris P, Van Dyke Russell, Wiener Jeffrey, Branson Bernard M
Division of HIV/AIDS Prevention, Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA.
JAMA. 2004 Jul 14;292(2):219-23. doi: 10.1001/jama.292.2.219.
Timely testing of women in labor with undocumented human immunodeficiency virus (HIV) status could enable immediate provision of antiretroviral prophylaxis.
To determine the feasibility and acceptance of rapid HIV testing among women in labor and to assess rapid HIV assay performance.
DESIGN, SETTING, AND PATIENTS: The Mother-Infant Rapid Intervention At Delivery (MIRIAD) study implemented 24-hour counseling and voluntary rapid HIV testing for women in labor at 16 US hospitals from November 16, 2001, through November 15, 2003. A rapid HIV-1 antibody test for whole blood was used.
Acceptance of HIV testing; sensitivity, specificity, and predictive value of the rapid test; time from blood collection to patient notification of results.
There were 91,707 visits to the labor and delivery units in the study, 7381 of which were by eligible women without documentation of HIV testing. Of these, 5744 (78%) women were approached for rapid HIV testing and 4849 (84%) consented. HIV-1 test results were positive for 34 women (prevalence = 7/1000). Sensitivity and specificity of the rapid test were 100% and 99.9%, respectively; positive predictive value was 90% compared with 76% for enzyme immunoassay (EIA). Factors independently associated with higher test acceptance included younger age, being black or Hispanic, gestational age less than 32 weeks, and having had no prenatal care. Lower acceptance was associated with being admitted between 4 pm and midnight, particularly on Friday nights, but this may be explained in part by fewer available personnel. Median time from blood collection to patient notification of result was 66 minutes (interquartile range, 45-120 minutes), compared with 28 hours for EIA (P<.001).
Rapid HIV testing is feasible and delivers accurate and timely test results for women in labor. It provides HIV-positive women prompt access to intrapartum and neonatal antiretroviral prophylaxis, proven to reduce perinatal HIV transmission, and may be particularly applicable to higher-risk populations.
及时对未记录人类免疫缺陷病毒（HIV）感染状况的临产妇女进行检测，可促使立即提供抗逆转录病毒药物预防。
确定临产妇女中快速HIV检测的可行性与接受度，并评估快速HIV检测的性能。
设计、地点与患者：母婴分娩时快速干预（MIRIAD）研究于2001年11月16日至2003年11月15日在美国16家医院对临产妇女实施了24小时咨询和自愿快速HIV检测。使用了全血快速HIV-1抗体检测。
HIV检测的接受度；快速检测的敏感性、特异性和预测值；从采血到向患者通知结果的时间。
研究中有91707人次前往产房，其中7381人次是符合条件但未记录HIV检测情况的妇女。其中，5744名（78%）妇女被邀请进行快速HIV检测，4849名（84%）同意检测。34名妇女的HIV-1检测结果呈阳性（患病率=7/1000）。快速检测的敏感性和特异性分别为100%和99.9%；阳性预测值为90%，而酶免疫测定（EIA）为76%。与较高检测接受度独立相关的因素包括年龄较小、为黑人或西班牙裔、孕周小于32周以及未接受过产前护理。接受度较低与下午4点至午夜之间入院有关，尤其是在周五晚上，但这部分可能是由于可用人员较少所致。从采血到向患者通知结果的中位时间为66分钟（四分位间距，45 - 120分钟），而EIA为（P<0.0）。
快速HIV检测对于临产妇女是可行的，并且能提供准确及时的检测结果。它为HIV阳性妇女提供了迅速获得产时和新生儿抗逆转录病毒药物预防的途径，已证明可减少围产期HIV传播，并且可能特别适用于高风险人群。
