Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #114728

Mitchell J. Besser, MD, Old Main Building, H Floor, Department of Obstetrics and Gynaecology, Groote Schuur Hospital, Observatory, Cape Town, 7925, South Africa, (+27)-83-327-7332, mbesser@ucsd.edu and Chineta R. Eure, MD, National Center for HIV, STD, and TB Prevention, Div. of HIV/AIDS Prevention, Surveillance, and Epidemiology, Centers for Disease Control and Prevention, 1600 Clifton Road, E-45, Atlanta, GA 30333.

Background: 25% of women attending public antenatal clinics in South Africa are HIV positive. Referral of HIV+ pregnant women who may require antiretroviral therapy is important. A simple antenatal clinical screening tool was developed to identify pregnant women with advanced HIV disease. The purpose of this study was to assess the correlation of screening tool items and TLC with the gold standard for advanced disease, a CD4+ cell count <200 cells/無 .Methods: 250 HIV+ pregnant women in antenatal clinics were administered the 23-item screening tool. The association between simultaneously drawn antenatal TLC and CD4+ cell count was evaluated using Pearson's correlation coefficient (cc). Odds ratios, sensitivities, specificities, and positive predictive values were computed to test the association between individual screening tool items and maternal CD4+ cell count <200 cells/無. Results: There was a moderate correlation of TLC with CD4+ counts (Pearson's cc, r =.63, p<.0001). Statistically significant factors associated with CD4+ cell count <200 cells/無 included: symptoms of weight loss, white coating on tongue, cough for >2 weeks; physical exam of oral thrush; and a TLC <1250 cells/無. Presence of any of these 5 factors demonstrated a sensitivity of 0.82, specificity of 0.67, and PPV of 0.50 for CD4+<200. Conclusions: TLC <1250 cells/無 and 4 screening items were associated with a CD4+ cell count <200 cells/無. Further refinement of an abbreviated screening tool using these factors could allow antenatal nurses in resource limited settings to make timely referrals of pregnant HIV+ pregnant women for specialized care and antiretroviral treatment.

Learning Objectives:

• To understand clinical screening for advanced HIV disease in pregnant women in resource-constrained settings.
• To understand surrogate laboratory tests for advanced HIV disesase in pregnant women in resource-contrained settings.

Keywords: HIV/AIDS, Screening Instruments

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.