Predictors of rapid HIV testing acceptance and successful nevirapine administration in Zambian labor wards.

Background: Provision of HIV testing in labor provides an Opportunity to reach susceptible women and infants. Methods: As part of a cluster randomized trial of labor ward-based prevention of mother-to-child transmission services in Lusaka, Zambia, we determined predictors of testing acceptance and nevirapine (NVP) administration in labor. HIV counseling and testing were offered to women unaware of their HIV status. NVP was administered to women who tested positive, and an inert (calcium) tablet was provided to women who tested negative, to avoid stigmatization. Results: Among the 2435 women who presented in labor, 393 (16%) were unaware of their HIV status, of whom 278 (71%) met eligibility criteria. We offered counseling to 217 (78%) of eligible women: 146 (67%) agreed, 82 (56%) of those counseled were tested for HIV, and 23 (28%) were seropositive. Testing rates were higher among primigravida women [adjusted odds ratio (AOR) 1.5; 95% confidence interval (CI): 1.1 to 2.1] and among those not offered HIV testing during their pregnancy (AOR 3.7; 95% CI: 2.8 to 5.1). Cervical dilation <= 3 cm at the time of admission was associated strongly with NVP ingestion > 1 hour (AOR 11.5; 95% CI: 4.5 to 29.2) and > 2 hours (AOR 11.4; 95% CI: 4.7 to 27.5) before delivery. Conclusion: Labor ward HIV testing is feasible in this resource-limited setting.