HIV Voluntary Counseling and Testing of Couples During Maternal Labor and Delivery: The TRIPAI Couples Study

Melo, Marineide MD, MSc*; Varella, Ivana PhD*; Castro, Andrea MSc*; Nielsen-Saines, Karin MD, MPH; Lira, Rita MD*; Simon, Mariana BS*; Yeganeh, Nava MD, MPH; Rocha, Taui MD*; Bogo Chies, José Artur MD; Santos, Breno MD*

doi: 10.1097/01.OLQ.0000430799.69098.c6
Original Study

Background: Women in Brazil are routinely tested for HIV-1 during pregnancy with rapid testing repeated during labor in some settings. Partner testing is not routinely offered. The peripartum period provides opportunity for HIV testing of couples.

Methods: A cross-sectional study was conducted in a large public hospital in southern Brazil. HIV rapid testing was offered to all pregnant women in labor. Male partners of women who consented to partner inclusion were offered testing. Within HIV-serodiscordant couples, HIV-negative individuals were evaluated for the delta-32 base-pair CCR5 deletion allele.

Results: From February to September 2009, 2888 women delivered, with 1729 eligible women approached for study participation; 1648 (95%) HIV-negative women consented to partner testing and 66% of partners accepted testing. Seven HIV-infected men (0.6%) with no prior diagnosis were identified. Testing strategies uncovered 7 additional serodiscordant couples, 4 HIV-infected women diagnosed at delivery, and 3 HIV-infected men who had not disclosed their status to their partners, for a total serodiscordance rate of 1.3% in 1101 couples. No cases of acute maternal or infant infection were noted. No delta-32 base-pair deletions were identified in 14 HIV-negative partners in serodiscordant relationships. Parameters associated with increased acceptance of partner testing included higher income (P = 0.003), education (P < 0.0001), stable relationships of longer duration (P = 0.001), and female support of partner testing (P < 0.0001).

Conclusions: Testing of couples at the time of labor and delivery is a feasible public health strategy in areas of moderate-to-high HIV prevalence, which can potentially prevent acute infections in men, women, and infants.

HIV testing of couples during maternal labor/delivery is feasible, with 95% and 66% acceptability among women and men, respectively. This approach uncovered 1.3% HIV serodiscordance in southern Brazilian couples.

From the *Grupo Hospitalar Conceiçao, Porto Alegre, Brazil; †David Geffen UCLA School of Medicine Department of Pediatrics, Los Angeles, CA; and ‡Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

Conflicts of Interest and Sources of Funding: The authors have no conflicts of interest to declare. The study was supported by a Post Translational Research Grant Award from the University of California, Los Angeles (UCLA) Department of Pediatrics, the UCLA Center for AIDS Research (5P30 AI28697), and the Los Angeles Brazil AIDS Consortium at UCLA (National Institute of Allergy and Infectious Diseases UM1 AI069401).

This study was partially presented at the 17th Conference on Retroviruses and Opportunistic Infections, San Francisco, CA, in February 2010.

Correspondence: Karin Nielsen-Saines, MD, MPH, Department of Pediatrics, David Geffen UCLA School of Medicine, MDCC 22-442, 10833 LeConte Ave, Los Angeles, CA 90095. E-mail: knielsen@mednet.ucla.edu.

Received for publication November 6, 2012, and accepted May 6, 2013.

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