Pilot study of expedited HIV-1 testing of women in labor at an inner-city hospital in New York city

To evaluate the feasibility of offering voluntary counseling and expedited human immunodeficiency virus (HIV) testing to women in labor, and to assess the characteristics of two rapid HIV assays compared with results from an expedited standard enzyme immunoassay (EIA), with Western blot confirmation , as indicated, we undertook a pilot study immediately prior to enactment o f New York State regulations (August 1999) requiring expedited testing of l aboring women (or newborns) with undocumented HIV status. From June 9, 1999 through July 2, 1999, we offered HIV counseling and testing (C&T) to all m edically stable women in active labor, 106 of 125 (85%) of whom accepted. O ne woman was confirmed HIV-1 seropositive. Rapid assay sensitivity and spec ificity were: SUDS 100 and 98%, and Multispot 100 and 100%, respectively in comparison with 100 and 99% fur the standard EIA. The positive predictive values (PPV) were SUDS 33%; Multispot 100%; and EIA 50%. While our sample s ize was small, it appears that the accuracy of rapid and expedited HIV assa ys may be improved by requiring two different reactive assays before inform ing women of HIV-seropositive results or initiating antiretroviral treatmen t.