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National Guidelines for the prevention of mother-to-child transmission of HIV across Europe - how do countries differ?

The aim was to summarize national prevention of mother-to-child transmission (PMTCT) guidelines across Europe and to identify differences between these. A survey was conducted using a structured questionnaire sent to experts in 25 European countries from January to March 2012, requesting a copy of t...

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Bibliographic Details
Published in:European journal of public health 2013-12, Vol.23 (6), p.1053-1058
Main Authors: Aebi-Popp, Karoline, Mulcahy, Fiona, Rudin, Christoph, Hoesli, Irene, Gingelmaier, Andrea, Lyons, Fiona, Thorne, Claire
Format: Article
Language:English
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Summary:The aim was to summarize national prevention of mother-to-child transmission (PMTCT) guidelines across Europe and to identify differences between these. A survey was conducted using a structured questionnaire sent to experts in 25 European countries from January to March 2012, requesting a copy of the national guidelines. Responses were received from 23 countries. Twenty-two (96%) countries supported a policy to recommend antenatal HIV screening for all pregnant women (15: opt-out strategy; 8: opt-in strategy). For HIV-positive women in whom the only indication for antiretroviral therapy (ART) was PMTCT, the recommended gestational age for commencing ART varied from 12 to 28 weeks: initiation before 19 weeks gestation was recommended in guidelines from nine countries; in France, the UK and the Netherlands, there was a wide range, from 14 to 24 weeks, whereas the Swiss and Ukrainian guidelines recommended starting at 24-28 weeks and the German/Austrian and Lithuanian at 28 weeks. Six national guidelines recommended inclusion of Zidovudine in antenatal ART regimens, and seven (37%) allowed continuation of Efavirenz for women conceiving on this drug. According to nine guidelines, zidovudine should always be used intrapartum. Eighteen national guidelines stated that HIV-positive women on successful ART can have a vaginal delivery. Viral load thresholds for vaginal delivery were
ISSN:1101-1262
1464-360X
DOI:10.1093/eurpub/ckt028