View larger version (17K):
[in a new window]
|
Figure. Screening for HIV—analytic framework for pregnant women. Key question (KQ) 1: Does screening for HIV in pregnant women reduce mother-to-child transmission or premature death and disability? KQ 2: Can clinical or demographic characteristics (including specific settings) identify subgroups of asymptomatic pregnant women at increased risk for HIV infection compared to the general population of pregnant women? KQ 3: What are the test characteristics of HIV antibody (HIV ab) test strategies in pregnant women? KQ 4: What are the harms (including labeling and anxiety) associated with screening? Is screening acceptable to pregnant women? KQ 5: How many HIV-infected pregnant women who meet criteria for interventions receive them? KQ 6: What are the harms associated with the work-up for HIV infection in pregnant women? KQ 7: a) How effective are interventions (antiretroviral prophylaxis [to prevent mother-to-child transmission] or treatment [to improve maternal outcomes]; avoidance of breastfeeding, elective cesarean section [in selected patients], or other labor management practices; counseling on risky behaviors; immunizations; routine monitoring and follow-up; or prophylaxis against opportunistic infections) in reducing mother-to-child transmission rates or improving clinical outcomes (mortality, functional status, quality of life, symptoms, or opportunistic infections) in pregnant women with HIV infection? b) Does immediate antiretroviral treatment in HIV-infected pregnant women result in improvements in clinical outcomes compared to delayed treatment until the infected woman becomes symptomatic? c) How well do interventions reduce the rate of viremia, improve CD4 cell counts, or reduce risky behaviors? How does identification of HIV infection in pregnant women affect future reproductive choices? KQ 8: What are the harms (including adverse effects from in utero exposure) associated with antiretroviral drugs and elective cesarean section? KQ 9: Have improvements in intermediate outcomes (CD4 cell counts, viremia, or risky behaviors) in HIV-infected pregnant women been shown to improve clinical outcomes or reduce mother-to-child transmission? A separate report (19) reviews KQs 6, 7b, 9, and parts of 7a (counseling, immunizations, labor management practices other than elective cesarean section, routine monitoring and follow-up, and prophylaxis against opportunistic infections); 7c (effects on viral loads, CD4 counts, and risky behaviors); and 9.
|
