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 AIDS Women and the Next Generation written by Ruth R. Faden and published by Oxford University Press, USA. This book was released on 1991 with total page 412 pages. Available in PDF, EPUB and Kindle. Book excerpt: The proliferation of Acquired Immune Deficiency Syndrome (AIDS) among women and children represents one of the gravest health issues confronting contemporary society. Women, most of childbearing age, now constitute 11 percent of all cases, and the U.S. Public Health Service has projected over 3,000 cases of pediatric AIDS by the end of 1991. In the face of these sobering statistics, experts have been called upon to grapple with a difficult, compelling question: under what conditions, if any, should HIV testing of women and children be required? Also at issue are the surreptitious testing for HIV antibodies as part of routine prenatal and neonatal examinations, and whether such testing should be performed on all women and infants, or only those who belong to groups judged at "high risk". In this unique contribution to the debate about HIV screening and testing, Ruth Faden, Madison Powers, and Gail Geller have assembled perspectives from experts in public health, medicine, law, and ethics. Their wide-ranging treatment examines the history of prenatal and neonatal screening programs; informed consent; legal issues and confidentiality; reproductive decision-making; and numerous other aspects of HIV testing. Alternative policy options for both now and the future are discussed in detail. This volume provides a comprehensive analysis of these pressing medical, public health, legal, ethical, and social issues, and is essential reading for AIDS researchers and clinicians, public health specialists, ethicists, health policymakers and analysts, obstetricians, and pediatricians.

Download or read book HIV Screening of Pregnant Women and Newborns written by Institute of Medicine and published by National Academies Press. This book was released on 1991-01-01 with total page 158 pages. Available in PDF, EPUB and Kindle. Book excerpt: Proposals for screening pregnant women and newborns for HIV infection have provoked much controversy. This volume analyzes the possible goals of such screening programs and assesses whether these goals can currently be achieved. It also provides guidance to policymakers in developing and implementing sound screening policy.

Download or read book Reducing the Odds written by National Research Council and published by National Academies Press. This book was released on 1999-02-13 with total page 426 pages. Available in PDF, EPUB and Kindle. Book excerpt: Thousands of HIV-positive women give birth every year. Further, because many pregnant women are not tested for HIV and therefore do not receive treatment, the number of children born with HIV is still unacceptably high. What can we do to eliminate this tragic and costly inheritance? In response to a congressional request, this book evaluates the extent to which state efforts have been effective in reducing the perinatal transmission of HIV. The committee recommends that testing HIV be a routine part of prenatal care, and that health care providers notify women that HIV testing is part of the usual array of prenatal tests and that they have an opportunity to refuse the HIV test. This approach could help both reduce the number of pediatric AIDS cases and improve treatment for mothers with AIDS. Reducing the Odds will be of special interest to federal, state, and local health policymakers, prenatal care providers, maternal and child health specialists, public health practitioners, and advocates for HIV/AIDS patients. January

Download or read book Guidelines for Perinatal Care written by American Academy of Pediatrics and published by . This book was released on 1997 with total page 436 pages. Available in PDF, EPUB and Kindle. Book excerpt: This guide has been developed jointly by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, and is designed for use by all personnel involved in the care of pregnant women, their foetuses, and their neonates.

Download or read book Screening for Human Immunodeficiency Virus in Pregnant Women 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: An estimated 6,000 to 7,000 HIV-infected women give birth each year in the United States. Although the number of cases of perinatally acquired HIV infection has declined sharply in the U.S. since the early 1990's, an estimated 280-370 HIV-infected infants were born each year between 1999 and 2001. OBJECTIVE: To synthesize the evidence on risks and benefits of screening for HIV infection in pregnant women. DATA SOURCES: MEDLINE(r) (through June 30, 2004), Cochrane Clinical Trials Registry (2004, Issue 2), reference lists, and experts. STUDY SELECTION: Controlled studies of screening and antiretrovirals, elective cesarean section, avoidance of breastfeeding, counseling, prophylaxis for opportunistic infections, immunizations, and routine monitoring and follow-up; observational studies of 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 in pregnant women with clinical outcomes. In developed countries, the rate of mother-to-child transmission from untreated HIV-infected women ranges from 14% to 25%. Targeted screening of pregnant women with risk factor assessment would miss a significant proportion of infected persons. Standard office-based testing is highly (>99%) sensitive and specific, and initial studies of rapid HIV tests in labor and delivery settings found similar diagnostic accuracy. Rapid testing may facilitate timely interventions in those testing positive. HIV testing rates during pregnancy continue to vary widely in the U.S. and appear to be higher in states using "opt-out" testing policies. Recommended interventions (combination antiretrovirals, elective cesarean section in selected patients, and avoidance of breastfeeding) are associated with transmission rates of 1%-2% in clinical trials and large observational studies. Shorter regimens are less effective, but also decrease the rate of transmission. Currently recommended combination antiretroviral regimens appear safe, but long-term follow-up is not yet available. Elective cesarean section is associated with an increased risk of mostly short-term adverse events. There are insufficient data to estimate the effects of interventions during pregnancy on long-term maternal outcomes. CONCLUSIONS: Identification and treatment of asymptomatic HIV infection in pregnant women can result in major reductions in mother-to-child transmission rates. The estimated benefits from combination antiretrovirals appear to greatly outweigh the risk of short-term complications. In settings with a maternal prevalence of 0.15%, the estimated number needed to screen to prevent one case of maternal-to-child transmission using conservative estimates of intervention effectiveness ranged from 3,500 to 12,170, and in settings with a maternal prevalence of 5%, ranged from 105 to 365. Data are insufficient to accurately estimate the long-term benefits of screening on maternal disease progression or other clinical outcomes (such as horizontal transmission). KEYWORDS: HIV, HIV infections, HIV seropositivity, mass screening, pregnancy.

Download or read book Counselling for Maternal and Newborn Health Care written by World Health Organization and published by World Health Organization. This book was released on 2010 with total page 240 pages. Available in PDF, EPUB and Kindle. Book excerpt: The main aim of this practical Handbookis to strengthen counselling and communication skills of skilled attendants (SAs) and other health providers, helping them to effectively discuss with women, families and communities the key issues surrounding pregnancy, childbirth, postpartum, postnatal and post-abortion care. Counselling for Maternal and Newborn Health Careis divided into three main sections. Part 1 is an introduction which describes the aims and objectives and the general layout of the Handbook. Part 2 describes the counselling process and outlines the six key steps to effective counselling. It explores the counselling context and factors that influence this context including the socio-economic, gender, and cultural environment. A series of guiding principles is introduced and specific counselling skills are outlined. Part 3 focuses on different maternal and newborn health topics, including general care in the home during pregnancy; birth and emergency planning; danger signs in pregnancy; post-abortion care; support during labor; postnatal care of the mother and newborn; family planning counselling; breastfeeding; women with HIV/AIDS; death and bereavement; women and violence; linking with the community. Each Session contains specific aims and objectives, clearly outlining the skills that will be developed and corresponding learning outcomes. Practical activities have been designed to encourage reflection, provoke discussions, build skills and ensure the local relevance of information. There is a review at the end of each session to ensure the SAs have understood the key points before they progress to subsequent sessions.

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 Perinatal Human Immunodeficiency Screening in Washington State written by Sarah Annette Wagner and published by . This book was released on 2006 with total page 45 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Screening for HIV in Pregnant Women 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 106 pages. Available in PDF, EPUB and Kindle. Book excerpt: The purpose of this report is to update a previous evidence review commissioned by the U.S. Preventive Services Task Force (USPSTF) on screening for asymptomatic HIV infection in pregnant women, including adolescents. In 2005, based on the earlier review, the USPSTF recommended that clinicians screen all pregnant women for HIV (grade A recommendation). Although the USPSTF found no studies that directly evaluated prenatal HIV screening versus no screening on risk of mother-to-child transmission or other clinical outcomes, it found good evidence that prenatal testing is accurate and acceptable to women and that treatment with recommended interventions (combination antiretrovirals, elective Cesarean delivery in women with viral loads greater than 1,000 copies/mL near the time of delivery, and avoidance of breastfeeding) is associated with major reductions in risk of mother-to-child transmission (from 14% to 25% in untreated women to 1% to 2% with treatment). The USPSTF concluded that benefits of treatments in reducing perinatal transmission substantially outweighed short-term harms, though evidence on long-term maternal or infant harms associated with screening and subsequent interventions was limited. The current report will be used by the USPSTF to update its 2005 recommendation on prenatal HIV screening. This update focuses on newer evidence on the accuracy and acceptability of rapid versus standard testing, the effectiveness of newer antiretroviral regimens for reducing mother-to-child transmission, long-term maternal outcomes following use of antiretroviral regimens during pregnancy, and maternal and infant harms associated with use of antiretroviral medications. Because perinatal practices and interventions related to prevention of HIV infection are substantially impacted by the availability of resources, the report will emphasize evidence applicable to typical practice in the United States. A major goal of prenatal screening for HIV is to reduce the risk of mother-to-child transmission through subsequent interventions. Other important goals are to improve long-term clinical outcomes in HIV-infected women, facilitate early identification of infected newborns, help women to make more informed future reproductive choices, and reduce risk of horizontal transmission through effects on risky behaviors. Using the methods developed by the USPSTF, the USPSTF and the Agency for Healthcare Research and Quality (AHRQ) determined the scope and key questions for this review. Investigators created an analytic framework with the key questions and patient populations, interventions, and outcomes reviewed. The target population for HIV screening was pregnant women without signs or symptoms of HIV infection. Key Questions include: Key Question 1. What are the benefits of HIV screening versus no screening in asymptomatic pregnant women on maternal or child morbidity, mortality, or quality of life or rates of mother-to-child transmission? Key Question 2a. What is the yield (number of new diagnoses) of repeat HIV screening in asymptomatic pregnant women? Key Question 2b. What are the adverse effects (including false-positive results and anxiety) of rapid versus standard HIV testing in asymptomatic pregnant women? Key Question 3a. What is the effectiveness of newer antiretroviral regimens for reducing mother-to- child transmission? Key Question 3b. What are the effects of antiretroviral regimens in pregnant, HIV-positive women on long-term maternal morbidity, mortality, or quality of life? Key Question 3c. What are the harms (including longer-term harms) to the mother or child associated with antiretroviral therapy during pregnancy?

Download or read book WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV related disease in adults and children written by and published by . This book was released on 2007 with total page 48 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Current Perspectives in HIV Infection written by Shailendra K. Saxena and published by BoD – Books on Demand. This book was released on 2013-04-10 with total page 484 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book gives a comprehensive overview of HIV and AIDS including NeuroAIDS, as well as general concepts of pathology, immunity and immunopathology, diagnosis, treatment, epidemiology and etiology to current clinical recommendations in management of HIV/AIDS including NeuroAIDS, highlighting the ongoing issues, recent advances and future directions in diagnostic approaches and therapeutic strategies.

Download or read book Perinatal AIDS written by and published by . This book was released on 1988 with total page 28 pages. Available in PDF, EPUB and Kindle. Book excerpt:

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 Knowledge of and Attitudes Towards Antenatal HIV Testing written by Daniela Carusi and published by . This book was released on 1997 with total page 170 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Consolidated Guideline on Sexual and Reproductive Health and Rights of Women Living with HIV written by World Health Organization and published by World Health Organization. This book was released on 2017-02-20 with total page 144 pages. Available in PDF, EPUB and Kindle. Book excerpt: he starting point for this guideline is the point at which a woman has learnt that she is living with HIV and it therefore covers key issues for providing comprehensive sexual and reproductive health and rights-related services and support for women living with HIV. As women living with HIV face unique challenges and human rights violations related to their sexuality and reproduction within their families and communities as well as from the health-care institutions where they seek care particular emphasis is placed on the creation of an enabling environment to support more effective health interventions and better health outcomes. This guideline is meant to help countries to more effectively and efficiently plan develop and monitor programmes and services that promote gender equality and human rights and hence are more acceptable and appropriate for women living with HIV taking into account the national and local epidemiological context. It discusses implementation issues that health interventions and service delivery must address to achieve gender equality and support human rights.

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?