Download or read book Screening for Human Immunodeficiency Virus in Adolescents and Adults written by and published by . This book was released on 2005 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Screening for Human Immunodeficiency Virus in Adolescents and Adults written by U. S. Department of Health and Human Services and published by CreateSpace. This book was released on 2013-06-22 with total page 270 pages. Available in PDF, EPUB and Kindle. Book excerpt: This evidence synthesis focuses on screening for unsuspected human immunodeficiency virus (HIV) using HIV antibody (Ab) tests in non-pregnant adolescents (aged 13 to 18 years old) and adults. The review will be used by the U.S. Preventive Services Task Force (USPSTF) to make recommendations regarding screening in the general adult and adolescent population. An accompanying report will review evidence regarding screening in pregnant women. Since the USPSTF published HIV screening recommendations in 1996, there have been substantial changes in the management and outcomes of chronic HIV infection. Although this report reviews the overall body of evidence regarding screening, it emphasizes recent data regarding the efficacy of highly active antiretroviral therapy (HAART) regimens, the accuracy and acceptability of new test methods, long-term risks of antiretroviral therapy, and the optimal timing of therapy in asymptomatic patients. HIV is an RNA retrovirus of the lentiretrovirus subfamily that was first isolated from a patient with AIDS in 1983. HIV is capable of particularly rapid replication and has a high propensity to mutate. There is significant genetic variation in HIV within individuals as well as populations. These characteristics explain some of the difficulties in developing effective vaccines and treatments. There remains no effective vaccine to prevent HIV infection and no cure for chronic infection. Interventions for HIV-infected patients include antiretroviral therapy, prophylaxis for opportunistic infections, immunizations, Papanicolaou testing, counseling to reduce high-risk behaviors, and routine monitoring and follow-up. HAART, defined as three or more antiretroviral agents used in combination (usually from at least two classes), is the standard of care for antiretroviral therapy.Key questions addressed include: KQ1. Does Screening for HIV Infection in Asymptomatic Adolescents and Adults Reduce Premature Death and Disability or Spread of Disease? KQ2. Can Clinical or Demographic Characteristics (Including Specific Settings) Identify Subgroups of Asymptomatic Adolescents and Adults at Increased Risk for HIV Compared to the General Population? KQ3. What are the Test Characteristics of HIV Antibody Test Strategies? KQ4. What are the Harms (Including Labeling and Anxiety) Associated with Screening? Is Screening Acceptable to Patients? KQ5. How Many Newly Diagnosed HIV-Positive Patients Meet Criteria for Antiretroviral Treatment or Prophylaxis for Opportunistic Infections? How Many Patients Who Meet Criteria for Interventions Receive Them? KQ6. What are the Harms Associated with the Work-Up for HIV Infection? KQ7a. How Effective are Interventions (Antiretroviral Treatment, Counseling on Risky Behaviors, Immunizations, Routine Monitoring and Follow-Up, More Frequent Papanicolaou Testing, or Prophylaxis for Opportunistic Infections) in Improving Clinical Outcomes (Mortality, Functional Status, Quality of Life, Symptoms, Opportunistic Infections, or Transmission Rates)? KQ7b. In Asymptomatic Patients with HIV Infection, Does Immediate Antiretroviral Treatment Result in Improvements in Clinical Outcomes Compared to Delayed Treatment Until Symptomatic? KQ7c. How Well Do Interventions Reduce the Rate of Viremia, Improve CD4 Counts, or Reduce Risky Behaviors? KQ8. What are the Harms Associated with Antiretroviral Therapy? KQ9. Have Improvements in Intermediate Outcomes (CD4 Counts, Viremia, Risky Behaviors) Been Shown to Reduce Premature Death and Disability or Spread of Disease?

Download or read book Screening for Human Immunodeficiency Virus in Adolescents and Adults written by Roger Chou and published by . This book was released on 2005 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: CONTEXT: Human immunodeficiency virus infection affects 850,000 to 950,000 persons in the United States, with approximately 40,000 new infections annually. Diagnosis of unsuspected HIV infection could identify those who would benefit from interventions or reduce transmission from those unaware of their status. OBJECTIVE: To synthesize the evidence on risks and benefits of screening for HIV infection. DATA SOURCES: MEDLINE (though June 30, 2004), Cochrane Clinical Trials Registry (2004, Issue 2), reference lists, and experts. STUDY SELECTION: Controlled studies of screening and antiretroviral therapy, counseling, prophylaxis for opportunistic infections, more frequent Papanicolaou smear testing, immunizations, and routine monitoring and follow-up; observational studies on counseling, risk factors, accuracy of antibody testing, work-up, acceptability of screening and uptake of interventions, harms of interventions and screening, and long-term outcomes. DATA EXTRACTION: Using preset criteria, the authors assessed the quality of included studies and abstracted information about settings, patients, interventions, and outcomes. DATA SYNTHESIS: There are no published trials directly linking screening for HIV with clinical outcomes. Approximately 0.3% of U.S. adults have HIV infection, and almost all will progress to AIDS if untreated. Risk factor assessment could identify adults at substantially higher risk, but would miss a significant proportion of infected persons. Screening tests for HIV are extremely accurate. Acceptance rates for screening and use of recommended interventions vary widely. Many persons are currently diagnosed at advanced stages of disease. Highly active antiretroviral treatment (HAART) reduces the risk of clinical progression or death compared to less intense regimens, and can result in sustained improvements in intermediate outcomes. HAART is associated with a significantly greater impact on clinical outcomes than other interventions. Although HAART is associated with significant short-term adverse events, these are usually self-limited and effective alternative regimens can be found. Increased duration of HAART use appears associated with an increased rate of cardiovascular complications over 3-4 years, but background rates of cardiovascular complications appear low. There are insufficient data to estimate the effects of counseling or HAART on transmission rates. CONCLUSIONS: Identification and treatment of unsuspected HIV infection at immunologically advanced stages of disease can result in marked reductions in clinical progression and mortality. Although long-term studies of HAART are not yet available, the estimated three-year benefits of HIV screening appear to greatly outweigh the risks of cardiovascular complications in both low- and high-prevalence settings using conservative estimates of the effectiveness of interventions. The yield from screening in populations with prevalence e1% would be substantially higher, however, than the yield from screening in the general population. Data are insufficient to accurately estimate the benefits (reduced clinical progression or spread of disease) from identifying HIV-infected persons at earlier stages of disease, or the effects of screening on the stage at which patients are diagnosed. KEYWORDS: HIV, HIV infections, HIV seropositivity, mass screening.

Download or read book Screening for Human Immunodeficiency Virus written by Roger Chou and published by . This book was released on 2007 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This report updates an evidence synthesis commissioned by the U.S. Preventive Services Task Force (USPSTF) and completed in March 2005, on screening for unsuspected human immunodeficiency virus (HIV) using HIV antibody (Ab) tests in non-pregnant adolescents (aged 13 to 18 years old) and adults. This brief update was requested by the USPSTF to determine whether there is sufficient new evidence to justify revision of recommendations based on the 2005 evidence synthesis. A key reason for this update is the release in September 2006 of revised Centers for Disease Control and Prevention (CDC) recommendations advising routine voluntary HIV screening of most U.S. adolescents and adults. The 2005 USPSTF recommendations differ from the revised CDC recommendations in that they do not recommend for or against routine screening non-pregnant adults and adolescents who do not report risk factors and are not in high-prevalence (>1%) or other high-risk settings. Staff at the CDC have indicated that the agency's expanded screening recommendations are based primarily on new evidence as to the effects of HIV screening on transmission risk. This report focuses on new or "breakthrough" evidence that could affect the 2005 USPSTF recommendations regarding routine screening of low- or average-risk adults and adolescents.

Download or read book Screening for Human Immunodeficiency Virus written by U. S. Department of Health and Human Services and published by CreateSpace. This book was released on 2013-06-22 with total page 36 pages. Available in PDF, EPUB and Kindle. Book excerpt: This report updates an evidence synthesis commissioned by the U.S. Preventive Services Task Force (USPSTF) and completed in March 2005, on screening for unsuspected human immunodeficiency virus (HIV) using HIV antibody (Ab) tests in non-pregnant adolescents (aged 13 to 18 years old) and adults. This brief update was requested by the USPSTF to determine whether there is sufficient new evidence to justify revision of recommendations based on the 2005 evidence synthesis. A key reason for this update is the release in September 2006 of revised Centers for Disease Control and Prevention (CDC) recommendations advising routine voluntary HIV screening of most U.S. adolescents and adults. The 2005 USPSTF recommendations differ from the revised CDC recommendations in that they do not recommend for or against routine screening non-pregnant adults and adolescents who do not report risk factors and are not in high-prevalence (greater than 1%) or other high-risk settings. Staff at the CDC have indicated that the agency's expanded screening recommendations are based primarily on new evidence as to the effects of HIV screening on transmission risk. This report focuses on new or “breakthrough” evidence that could affect the 2005 USPSTF recommendations regarding routine screening of low- or average-risk adults and adolescents. This update reviews new evidence on HIV screening not included in the 2005 evidence synthesis. It focuses on evidence in non-pregnant, adults and adolescents who do not report risk factors and are evaluated in lower-prevalence (less than 1%), low-risk clinical settings (referred to in this report as 'low-risk' persons), because this is the population for which the USPSTF and the 2006 CDC recommendations are discordant. In the 2005 evidence review, we identified several key areas where additional evidence could strengthen the case for screening in low-risk populations. These include gaps in the research regarding uncertainties about the acceptability of routine voluntary screening in low-risk persons; the yield of targeted versus universal screening and optimal methods of risk assessment in low-risk settings; the impact on test uptake and follow-up of abbreviated or streamlined counseling methods and newer testing or sampling methods; and the effects of screening on HIV transmission rates. We therefore focused on studies that could help fill in these gaps. We also evaluated new evidence on the cost-effectiveness of routine HIV screening and studies on the frequency of testing.

Download or read book Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection written by World Health Organization and published by . This book was released on 2016 with total page 429 pages. Available in PDF, EPUB and Kindle. Book excerpt: These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care. This edition updates the 2013 consolidated guidelines on the use of antiretroviral drugs following an extensive review of evidence and consultations in mid-2015, shared at the end of 2015, and now published in full in 2016. It is being published in a changing global context for HIV and for health more broadly.

Download or read book Revised Recommendations for HIV Testing of Adults Adolescents and Pregnant Women in Health care Settings written by and published by . This book was released on 2006 with total page 17 pages. Available in PDF, EPUB and Kindle. Book excerpt: "These recommendations for human immunodeficiency virus (HIV) testing are intended for all health-care providers in the public and private sectors, including those working in hospital emergency departments, urgent care clinics, inpatient services, substance abuse treatment clinics, public health clinics, community clinics, correctional health-care facilities, and primary care settings. The recommendations address HIV testing in health-care settings only. They do not modify existing guidelines concerning HIV counseling, testing, and referral for persons at high risk for HIV who seek or receive HIV testing in nonclinical settings (e.g., community-based organizations, outreach settings, or mobile vans). The objectives of these recommendations are to increase HIV screening of patients, including pregnant women, in health-care settings; foster earlier detection of HIV infection; identify and counsel persons with unrecognized HIV infection and link them to clinical and prevention services; and further reduce perinatal transmission of HIV in the United States. These revised recommendations update previous recommendations for HIV testing in health-care settings and for screening of pregnant women (CDC. Recommendations for HIV testing services for inpatients and outpatients in acute-care hospital settings. MMWR 1993;42[No. RR-2]:1-10; CDC. Revised guidelines for HIV counseling, testing, and referral. MMWR 2001;50[No. RR-19]:1-62; and CDC. Revised recommendations for HIV screening of pregnant women. MMWR 2001;50[No. RR-19]:63-85). Major revisions from previously published guidelines are as follows: For patients in all health-care settings HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Persons at high risk for HIV infection should be screened for HIV at least annually. Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings. For pregnant women HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women. HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. Repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant women."--Page 1.

Download or read book College Students Knowledge of Human Immunodeficiency Virus and Willingness to Participate in Screening written by Alison Campbell and published by . This book was released on 2020 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt: An estimated 1.2 million adults and adolescents are living with human immunodeficiency virus (HIV) in the United States and approximately 50,000 are newly infected each year. If HIV is left untreated, the disease will eventually progress to acquired immunodeficiency syndrome (AIDS). HIV continues to be a concern in public health, yet the public perception about the severity of the HIV epidemic has declined in recent years. Although research suggests that college students are highly educated on modes of transmission for HIV, they continue to practice risky sexual behaviors that will increase their risk of HIV transmission. The researchers in this study utilized a descriptive, non-experimental, quantitative design to determine college students' knowledge regarding HIV and their willingness to be tested for HIV. Data analysis revealed that college age students were not knowledgeable of HIV. Findings revealed a great need for further education regarding HIV knowledge and HIV testing among college students in the southeastern United States.

Download or read book The AIDS Challenge written by Marcia Quackenbush and published by Network Press. This book was released on 1988 with total page 546 pages. Available in PDF, EPUB and Kindle. Book excerpt: Thirty essays address issues related to educating youth of all ages about AIDS.

Download or read book Disease Control Priorities Third Edition Volume 6 written by King K. Holmes and published by World Bank Publications. This book was released on 2017-11-06 with total page 1027 pages. Available in PDF, EPUB and Kindle. Book excerpt: Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.

Download or read book Screening for HIV Infection in Asymptomatic Nonpregnant Adolescents and Adults written by Roger Chou and published by . This book was released on 2019 with total page 121 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: A 2012 systematic review on HIV screening for the U.S. Preventive Services Task Force (USPSTF) found strong evidence that antiretroviral therapy (ART) is associated with improved clinical outcomes in persons with CD4+ T helper cell (CD4) counts less than 500 cells/mm3 and substantially decreases risk of HIV transmission, with certain antiretroviral agents potentially associated with long-term cardiovascular harms. The USPSTF previously found HIV screening tests to be highly accurate. PURPOSE: To systematically update the 2012 USPSTF review on screening for HIV in adolescents and adults, focusing on research gaps identified in the prior review. DATA SOURCES: We searched the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and MEDLINE (2012 to June 2018) and manually reviewed reference lists, with surveillance through January 2019. STUDY SELECTION: Randomized, controlled trials (RCTs) and controlled observational studies on benefits and harms of screening versus no screening and on the yield of screening at different intervals; the effects of earlier versus later initiation of ART; and long-term (≥2 years) harms of ART. DATA EXTRACTION: One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. DATA SYNTHESIS (RESULTS): We did not identify any studies on benefits or harms of HIV screening versus no screening, or on the yield of repeat versus one-time screening or of screening at different intervals. Two new RCTs conducted completely or partially in low-resource settings found initiation of ART in persons with CD4 counts greater than 500 cells/mm3 associated with lower risk of composite clinical outcomes (mortality, AIDS-defining events, or serious non-AIDS events) (relative risk [RR], 0.44 [95% confidence interval (CI), 0.31 to 0.63] and RR, 0.57 [95% CI, 0.35 to 0.95]); early initiation of ART was not associated with increased risk of cardiovascular events. A large observational study also found initiation of ART in persons in high-resource settings with CD4 counts greater than 500 cells/mm3 to be associated with reduced risk of mortality or AIDS events, although the magnitude of effect was smaller. New evidence regarding the association between abacavir use and increased risk of cardiovascular events was inconsistent, and certain antiretroviral regimens were associated with increased risk of long-term neuropsychiatric, renal, hepatic, and bone adverse events. LIMITATIONS: Only English-language articles were included. Observational studies were included. Studies conducted in resource-poor settings were included, which might limit applicability to general screening in the United States. CONCLUSIONS: New evidence extends effectiveness of ART to asymptomatic persons with CD4 counts greater than 500 cells/mm3. Certain ART regimens may be associated with long-term cardiovascular, neuropsychiatric, hepatic, renal, or bone harms, but early initiation of ART is not associated with increased risk of cardiovascular events. Research is needed to inform optimal screening intervals.

Download or read book Screening for HIV Systematic Review to Update the U S Preventive Services Task Force Recommendation written by U. S. Department of Health and Human Services and published by Createspace Independent Pub. This book was released on 2013-04-17 with total page 184 pages. Available in PDF, EPUB and Kindle. Book excerpt: The purpose of this report is to update a previous systematic review commissioned by the U.S. Preventive Services Task Force (USPSTF) on screening for asymptomatic HIV infection in nonpregnant adults and adolescents. In 2005, based on the earlier evidence review, the USPSTF recommended screening all adolescents and adults at increased risk for HIV infection (grade A recommendation). The USPSTF based its recommendation on the high yield of screening in these patients, good evidence that standard and rapid HIV screening tests accurately detect HIV infection, and good evidence that identification and treatment of unsuspected HIV infection at immunologically advanced stages of disease with antiretroviral therapy (ART) and other interventions results in marked reduction in risk of progression to acquired immunodeficiency syndrome (AIDS) and AIDS-related clinical events and mortality. Although the USPSTF found ART associated with short-term adverse events and increased risk of long-term cardiovascular events, it determined that estimated benefits greatly outweighed harms. The USPSTF made no recommendation for or against routinely screening for HIV in adolescents and adults not at increased risk for HIV infection (grade C recommendation). Because of the lower prevalence of HIV infection in persons not at increased risk, the USPSTF determined that benefits from screening would be smaller than screening in higher-risk populations, resulting in a close balance between potential benefits and harms, including false-positive results, labeling, anxiety, and adverse events associated with ART and other interventions. Importantly, the USPSTF found insufficient evidence to estimate benefits from screening in persons at less immunologically advanced stages of disease or effects of screening and subsequent interventions on risk of HIV transmission. In 2006, the Centers for Disease Control and Prevention (CDC) issued its revised guideline recommending routine voluntary HIV screening of all persons ages 13 to 64 years, unless the prevalence of undiagnosed HIV infection has been documented to be less than 0.1 percent. The CDC also recommended that testing be performed on an opt-out basis without a requirement for pretest prevention counseling, in order to reduce barriers to screening. A key reason for the differences between the CDC and USPSTF recommendations is evidence showing that 20 to 26 percent of patients with HIV infection report no risk factors, suggesting that any screening strategy based on risk factor identification will miss an important proportion of infected persons. Other reasons for the differences between the CDC and USPSTF recommendations include greater weight placed by the CDC on studies showing reductions in self-reported risky behaviors following diagnosis of HIV infection, acceptance of modeling studies to estimate effects of HIV diagnosis and reductions in risky behaviors on transmission risk, and greater weight placed on studies showing acceptable incremental cost-effectiveness ratios for screening versus no screening in very low-prevalence populations. The USPSTF subsequently commissioned a focused update of its 2005 report with the studies included in the CDC guideline, but found insufficient evidence to change its C recommendation on screening in persons not at higher risk. The USPSTF found methodological shortcomings in the studies showing reduced risky behaviors following HIV diagnosis, which made estimations of reductions in transmission risk unreliable. This report updates the prior USPSTF review on the benefits and harms of HIV screening in nonpregnant adolescents and adults, focusing on key research gaps identified in the earlier review. This report also addresses areas not addressed in the prior USPSTF review, including effects of different screening methods on uptake, CD4 count at diagnosis, linkage to followup care, and harms, in order to help inform optimal screening strategies.

Download or read book AIDS and Adolescents written by Lorraine Sherr and published by Taylor & Francis. This book was released on 1997 with total page 224 pages. Available in PDF, EPUB and Kindle. Book excerpt: This text provides insight into a wide range of adolescent issues. A series of contributions examines facts and fictions associated with adolescent risk, challenging some of the basic current notions underpinning approaches to the subject.

Download or read book Consolidated guidelines on HIV prevention testing treatment service delivery and monitoring written by World Health Organization and published by World Health Organization. This book was released on 2021-07-16 with total page 592 pages. Available in PDF, EPUB and Kindle. Book excerpt: These consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring bring together existing and new clinical and programmatic recommendations across different ages, populations and settings, bringing together all relevant WHO guidance on HIV produced since 2016. It serves as an update to the previous edition of the consolidated guidelines on HIV. These guidelines continue to be structured along the continuum of HIV care. Information on new combination prevention approaches, HIV testing, ARV regimens and treatment monitoring are included. There is a new chapter on advanced HIV disease that integrates updated guidance on the management of important HIV comorbidities, including cryptococcal disease, histoplasmosis and tuberculosis. The chapter on general HIV care, contains a new section on palliative care and pain management, and up to date information on treatment of several neglected tropical diseases, such as visceral leishmaniasis and Buruli ulcer. New recommendations for screening and treating of cervical pre-cancer lesions in women living with HIV are also addressed in this chapter. Guidance on service delivery was expanded to help the implementation and strengthening the HIV care cascade. Importantly, this guidance emphasizes the need for differentiated approaches to care for people who are established on ART, such as reduced frequency of clinic visits, use of multi-month drug dispensing and implementation of community ART distribution. The adoption of these efficiencies is essential to improve the quality of care of people receiving treatment and reduce the burden on health facilities, particularly in resource limited settings.

Download or read book Adolescent Risk and Vulnerability written by National Research Council and published by National Academies Press. This book was released on 2001-10-08 with total page 164 pages. Available in PDF, EPUB and Kindle. Book excerpt: Adolescents obviously do not always act in ways that serve their own best interests, even as defined by them. Sometimes their perception of their own risks, even of survival to adulthood, is larger than the reality; in other cases, they underestimate the risks of particular actions or behaviors. It is possible, indeed likely, that some adolescents engage in risky behaviors because of a perception of invulnerabilityâ€"the current conventional wisdom of adults' views of adolescent behavior. Others, however, take risks because they feel vulnerable to a point approaching hopelessness. In either case, these perceptions can prompt adolescents to make poor decisions that can put them at risk and leave them vulnerable to physical or psychological harm that may have a negative impact on their long-term health and viability. A small planning group was formed to develop a workshop on reconceptualizing adolescent risk and vulnerability. With funding from Carnegie Corporation of New York, the Workshop on Adolescent Risk and Vulnerability: Setting Priorities took place on March 13, 2001, in Washington, DC. The workshop's goal was to put into perspective the total burden of vulnerability that adolescents face, taking advantage of the growing societal concern for adolescents, the need to set priorities for meeting adolescents' needs, and the opportunity to apply decision-making perspectives to this critical area. This report summarizes the workshop.

Download or read book Screening for Human Immunodeficiency Virus in Pregnant Women Evidence Synthesis written by U. S. Department of Health and Human Services and published by CreateSpace. This book was released on 2013-07-01 with total page 120 pages. Available in PDF, EPUB and Kindle. Book excerpt: This evidence synthesis focuses on screening for unsuspected human immunodeficiency virus (HIV) using HIV antibody (Ab) tests in pregnant women, including adolescents. Since the USPSTF last published recommendations regarding HIV screening of pregnant Women, there have been substantial changes in the management of pregnant women with HIV and in the rates of mother-to-child transmission. Although this report reviews the overall body of evidence regarding screening for HIV infection in pregnant women, it focuses on more recent data regarding the efficacy of combination antiretroviral regimens in prevention of mother-to-child transmission, harms associated with receipt of antiretrovirals in pregnancy, and the accuracy and acceptability of rapid testing. There is no effective vaccine to prevent HIV infection and no cure for chronic infection. In HIV-infected pregnant women, a major goal of interventions is to reduce the risk of mother-to child transmission. Other important goals are to improve clinical outcomes in the mother, facilitate early identification of infected newborns, allow women to make informed future reproductive choices, and prevent horizontal transmission through counseling on risky behaviors. Interventions for HIV-infected pregnant women include antiretroviral therapy, avoidance of breastfeeding, specific labor and delivery management techniques such as cesarean section before labor and before rupture of membranes (elective cesarean section), prophylaxis for opportunistic infections, immunizations, counseling to reduce high-risk behaviors, and regular monitoring and follow-up. In the U.S., receipt of combination antiretrovirals in conjunction with elective cesarean section in selected women and avoidance of breastfeeding is the standard of care to reduce mother-to-child transmission of HIV. Management of HIV infection in pregnancy is a rapidly evolving area. Key Questions addressed include: KQ1. Does Screening for HIV in Asymptomatic Pregnant Women Reduce Mother-to-Child Transmission or Premature Death and Disability? KQ2. Can Clinical or Demographic Characteristics (Including Persons in Specific Settings) Identify Subgroups of Asymptomatic Pregnant Women at Increased Risk for HIV Infection Compared to the General Population of Pregnant Women? KQ3. What Are the Test Characteristics of HIV Antibody Test Strategies in Pregnant Women? KQ4. What Are the Harms (Including Labeling and Anxiety) Associated with Screening? Is Screening Acceptable to Pregnant Women? KQ5. How Many HIV-Infected Pregnant Women Who Meet Criteria for Interventions Receive Them? KQ6. What Are the Harms Associated with the Work-up for HIV Infection in Pregnant Women? KQ7a. 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 for Opportunistic Infections) in Reducing Transmission Rates or Improving Clinical Outcomes (Mortality, Functional Status, Quality of Life, Symptoms, or Opportunistic Infections) in Pregnant Women with HIV Infection? KQ7b. Does Immediate Antiretroviral Treatment in HIV-Infected Pregnant Women Result in Improvements in Clinical Outcomes Compared to Delayed Treatment until Symptomatic? KQ7c. How Well Do Interventions Reduce the Rate of Viremia, Improve CD4 Counts, and Reduce Risky Behaviors? How Does Identification of HIV Infection in Pregnant Women Affect Future Reproductive Choices? KQ8. What Are the Harms (Including Adverse Effects from In Utero Exposure) Associated with Antiretroviral Intervention and Elective Cesarean Section? KQ9. Have Improvements in Intermediate Outcomes (CD4 Counts, Viremia, or Risky Behaviors) in HIV Infected Pregnant Women Been Shown to Improve Clinical Outcomes or Reduce Mother-to-Child Transmission?

Download or read book State Minor Consent Laws written by Abigail English and published by . This book was released on 2010 with total page 286 pages. Available in PDF, EPUB and Kindle. Book excerpt: "State Minor Consent Laws: A Summary 3rd Edition, summarizes the laws in each of the 50 U.S. states and the District of Columbia that allow minors to give their own consent for health care. A brief overview of the laws in each jurisdiction is provided. The laws summarized for each jurisdiction are divided into two groups: laws that are based on the status of the minor; and laws that are based on the type of health care the minor is seeking."--Preface.