Abstract
BackgroundEffective interventions to prevent mother-to-child HIV transmission (PMTCT) exist and when properly applied reduce the risk of vertical HIV transmission. As part of optimizing PMTCT in the Dutch Caribbean we developed a set of valid and applicable indicators in order to assess the quality of care in HIV-infected (pregnant) women and their newborns.MethodsA multidisciplinary expert panel of 19 experts reviewed and prioritized recommendations extracted from locally used international PMTCT guidelines according to a 3-step-modified-Delphi procedure. Subsequently, the feasibility, sample size, inter-observer reliability, sensitivity to change and case mixed stability of the potential indicators were tested for a data set of 153 HIV-infected women, 108 pregnancies of HIV-infected women and 79 newborns of HIV-infected women in Aruba, Curaçao and St Maarten from 2000 to 2010.ResultsThe panel selected and prioritized 13 potential indicators. Applicability could not be tested for 4 indicators regarding HIV-screening in pregnant women because of lack of data. Four indicators performed satisfactorily for Curaçao ('monitoring CD4-cell count', 'monitoring HIV-RNA levels', 'intrapartum antiretroviral therapy and infant prophylaxis if antepartum antiretroviral therapy was not received', 'scheduled caesarean delivery') and 3 for St Maarten ('monitoring CD4-cell count', 'monitoring HIV-RNA levels', 'discuss and provide combined antiretroviral therapy to all HIV-infected pregnant women') whilst none for Aruba.ConclusionsA systemic evidence-and consensus-based approach was used to develop quality indicators in 3 Dutch Caribbean settings. The varying results of the applicability testing accentuate the necessity of applicability testing even in, at first, comparable settings.
Highlights
Effective interventions to prevent mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT) exist and when properly applied reduce the risk of vertical HIV transmission
The Dutch Caribbean consists of Aruba and the Netherlands Antilles (Saba, St Eustatia, Bonaire, St Maarten and Curaçao) and has an estimated prevalence of HIV-1-infection of 0.61%-1.05% in the adult population [10]
Since 1996 guidelines regarding the prevention of mother-to-child HIV transmission (PMTCT) have been implemented in regular health care systems in the Dutch Caribbean and the annual number of paediatric HIV-cases has dropped dramatically since [10]
Summary
Effective interventions to prevent mother-to-child HIV transmission (PMTCT) exist and when properly applied reduce the risk of vertical HIV transmission. As part of optimizing PMTCT in the Dutch Caribbean we developed a set of valid and applicable indicators in order to assess the quality of care in HIV-infected (pregnant) women and their newborns. The Dutch Caribbean consists of Aruba and the Netherlands Antilles (Saba, St Eustatia, Bonaire, St Maarten and Curaçao) and has an estimated prevalence of HIV-1-infection of 0.61%-1.05% in the adult population [10]. Since 1996 guidelines regarding the prevention of mother-to-child HIV transmission (PMTCT) have been implemented in regular health care systems in the Dutch Caribbean and the annual number of paediatric HIV-cases has dropped dramatically since [10]. Monitoring and evaluating the quality of care in HIVinfected women to achieve PMTCT is important as it can identify strategies to improve the quality of care provided and thereby lead to a better outcome in the prevention of HIV transmission [11]. As part of optimizing the quality of prenatal and delivery care in HIVinfected (pregnant) women in the Dutch Caribbean, this study aims to develop a validated and applicable set of quality indicators to measure the quality of care in HIVinfected (pregnant) women and their newborns in 3 Dutch Caribbean settings; Aruba, Curaçao and St Maarten
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