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Question
Should pregnant women with unknown HIV status be offered rapid HIV testing in labour?
  1. Jonathan Downie1,
  2. Helen Mactier2,
  3. Ruth M Bland1,3,4
  1. 1Department of General Paediatrics, Royal Hospital for Children, Glasgow, Lanarkshire, UK
  2. 2Princess Royal Maternity Neonatal Unit, Glasgow, Lanarkshire, UK
  3. 3Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
  4. 4Institute of Health and Wellbeing, University of Glasgow, Glasgow, Lanarkshire, UK
  1. Correspondence to : Dr Jonathan Downie, Department of General Paediatrics, Office Block,Royal Hospital for Children, New South Glasgow University Campus, Glasgow G51 4TF, UK;jonathan.downie85{at}gmail.com

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Scenario

A primiparous woman from Central Africa presents to a maternity unit in Scotland for a booking appointment at 38 weeks’ gestation. She agrees to antenatal testing and routine bloods, including HIV serology. Urgent testing is not requested. The woman presents again in established labour 72 h later and delivers a healthy infant vaginally. In the absence of a positive result in the maternal notes, HIV serology is assumed to be negative. Mother and infant are discharged on day 2 of life, mixed breastfeeding (ie, breast milk and formula milk). A positive maternal HIV result is reported to the paediatric and obstetric team, on day 5 post partum, with a high maternal viral load. Mother and infant are recalled urgently to the neonatal unit and arrangements are made for them to be seen promptly by the HIV multidisciplinary team. Bloods are taken from the baby and she is commenced immediately on triple antiretroviral therapy which is continued for a total of 4 weeks. The mother is advised to formula feed. HIV testing (proviral DNA) on the infant is negative on Day 5 and at 6 weeks, however repeat testing at 3 months is positive. Would the use of rapid HIV testing in labour have altered the management of this woman during delivery and subsequent infant feeding advice, preventing this infant from contracting HIV?

Search strategy and outcome

PubMed and the Cochrane Library were searched in May 2013. The following free text terms were used (“pregnant woman” OR “pregnant women” OR “women in labour” OR “pregnant mothers”) and (“rapid HIV test” OR “HIV test in labour” OR “rapid HIV screening”) and (“unknown HIV” OR “unknown HIV status”). Limit set: English Language. Studies from all countries were included. All citations were screened by the author and a total of 23 were found. Relevant citations identified in the first screen were evaluated by …

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