Developing quality indicators for the care of HIV-infected pregnant women in the Dutch Caribbean

• Published in: AIDS research and therapy 2011-09, Vol.8 (1), p.32-32
• Main Authors: Hermanides, Hillegonda S, van Vught, Lonneke A, Voigt, Ralph, Muskiet, Fred D, Durand, Aimée, van Osch, Gerard, Koolman-Wever, Sharline, Gerstenbluth, Isaac, Smit, Colette, Duits, Ashley J
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiviral agents; Care and treatment; Caribbean; Health aspects; HIV; HIV infection; HIV patients; Hospitals; Human immunodeficiency virus; Mother-to-Child Transmission; Pregnancy; Pregnant women; Prevention; quality indicator; Womens health
• ISSN: 1742-6405; 1742-6405
• DOI: 10.1186/1742-6405-8-32

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. A 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. The 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. A 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.