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Table 2 Applicability of potential quality indicators for the care of HIV-1-infected (pregnant) women and their newborns in Curaçao, Aruba and St Maarten.

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

Indicator, setting Sample size, number of patients Feasibility, % of available data Inter-rater reliability, κ Sensitivity to change, % Case-mix stable
Pregnant women      
1. HIV testing should be done in all pregnant women. NA 0 NA NA NA
2. Pregnant women who decline HIV testing should be encouraged to be tested at subsequent visits. NA 0 NA NA NA
3. Repeat HIV testing if risk factors are present during pregnancy. NA 0 NA NA NA
4. Perform HIV rapid testing if HIV status is unknown at labour. NA 0 NA NA NA
HIV-infected women      
5. Offer preconception counseling and care to HIV-infected women of childbearing potential.      
   Total 153 31 0.54 45 Yes
   Curaçao 136 18 0.60 35 Yes
   Aruba 17 59 < 0.0 83 Yes
   St Maarten NA 0 NA NA NA
6. Maximally suppress plasma HIV RNA levels prior to conception in HIV-infected women who wish to get pregnant.      
   Total 14 18 0.82 50 Yes
   Curaçao 12 15 0.82 50 Yes
   Aruba 2 18 1 50 NA
   St Maarten NA 0 NA NA NA
HIV-infected pregnant women      
7. Monitor CD4 cell count at the initial visit and at least every 3 months during pregnancy.      
   Total 91 97 0.92 16 No 2
   Curaçao 54 94 1 18 Yes
   Aruba 8 100 1 0 NA
   St Maarten 29 100 0.67 18 Yes
8. Monitor plasma HIV RNA levels at initial visit, 2 to 6 weeks after start antiretroviral therapy, monthly until undetectable, and then at least every 2 months during pregnancy.      
   Total 91 81 0.92 0 NA
   Curaçao 54 80 0.86 0 NA
   Aruba 8 100 1.0 0 NA
   St Maarten 29 80 0.67 0 NA
9. Discuss and provide combined antiretroviral prophylaxis to all      
HIV-infected pregnant women, regardless HIV RNA levels.      
   Total 91 92 0.57 74 Yes
   Curaçao 54 91 0.52 77 Yes
   Aruba 8 100 0.67 75 NA
   St Maarten 29 93 1 70 Yes
10. Give intrapartum and infant antiretroviral prophylaxis to all HIV-infected pregnant women who do not receive antepartum antiretroviral therapy.      
   Total 24 92 0.76 0 NA
   Curaçao 16 91 0.72 0 NA
   Aruba 2 100 0.67 0 NA
   St Maarten 6 93 1 0 NA
11. Perform a cesarean delivery at 38 weeks gestation if HIV RNA levels > 400 copies/mL or unknown.      
   Total 53 92 0.74 49 No 3
   Curaçao 35 96 0.93 60 Yes
   Aruba 7 100 0.60 29 NA
   St Maarten 11 83 0.35 27 Yes
12. Counsel HIV-infected pregnant women to avoid breastfeeding.      
   Total 91 65 0.06 81 Yes
   Curaçao 54 67 -0.29 50 Yes
   Aruba 8 100 0 88 NA
   St Maarten 29 52 1 93 No1
Newborn      
13. Continue antiretroviral prophylaxis in the newborn during 4 weeks post partum.      
   Total 79 24 0.77 79 Yes
   Curaçao 49 24 0.81 50 Yes
   Aruba 8 75 0.11 33 NA
   St Maarten 22 50 1 93 Yes
  1. The indicators that were applicable in practice are shown in boldface font. NA, not applicable. 1Correction for multiparity, 2Correction for women not born in Dutch Caribbean, multi-parity and age, 3Correction for insurance type.