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 | Â | Â | Â | Â | Â |
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 | Â | Â | Â | Â | Â |
5. Offer preconception counseling and care to HIV-infected women of childbearing potential. | Â | Â | Â | Â | Â |
   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. | Â | Â | Â | Â | Â |
   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 | Â | Â | Â | Â | Â |
7. Monitor CD4 cell count at the initial visit and at least every 3 months during pregnancy. | Â | Â | Â | Â | Â |
   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. | Â | Â | Â | Â | Â |
   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 | Â | Â | Â | Â | Â |
HIV-infected pregnant women, regardless HIV RNA levels. | Â | Â | Â | Â | Â |
   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. | Â | Â | Â | Â | Â |
   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. | Â | Â | Â | Â | Â |
   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. | Â | Â | Â | Â | Â |
   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 | Â | Â | Â | Â | Â |
13. Continue antiretroviral prophylaxis in the newborn during 4 weeks post partum. | Â | Â | Â | Â | Â |
   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 |