British HIV Association guidelines for the management of<scp>HIV</scp>infection in pregnant women 2012

Taylor, Graham P.; Clayden, Polly; Dhar, Jyoti; Gandhi, Kate; Gilleece, Yvonne; Harding, Kate; Hay, P; Kennedy, Jane; Low‐Beer, Naomi; Lyall, Hermione; Palfreeman, Adrian; Tookey, P; Welch, S; Wilkins, E.G.L.; Ruiter, Annemiek de

doi:10.1111/j.1468-1293.2012.01030.x

Cited by 106 publications

(96 citation statements)

References 296 publications

(215 reference statements)

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“…Overview of fertility-related research areas for women of reproductive age. 23(45): [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] many factors aside from HIV influence decisions to terminate pregnancy, and that abortion is less common among women living with HIV in the antiretroviral era. 3,26 Further knowledge regarding post-abortion care and approaches to effectively integrate HIV and post-abortion care services should be expanded.…”

Section: Resultsmentioning

confidence: 99%

“…32 With a limited number of studies, service delivery records related to preconception care, specifically data characterizing safer conception services aiming to minimize the risk of sexual or vertical HIV transmission for HIV-affected couples trying to become pregnant, are scarce. 33 Guidelines for safer conception -relevant to both women living with HIV and women affected by HIV through their partner's HIV status-are available in several high-income countries as well as in South Africa, [34][35][36][37][38] and are under development by the World Health Organization. However, safer conception implementation has been largely limited to high income settings where resources and infrastructure facilitate options including spermwashing, intrauterine insemination (IUI), in-vitro fertilization (IVF), [39][40][41] and/or close monitoring of natural conception while using antiretrovirals.…”

Section: Resultsmentioning

confidence: 99%

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Fertility-related research needs among women at the margins

Schwartz¹,

Baral

2015

Reproductive Health Matters

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Fertility-related research encompasses fertility intentions, preconception care, research amongst pregnant women, and post-partum outcomes of mothers and children. However, some women remain underrepresented within this domain of study. Women frequently missing within fertility-related research include those who are already the most vulnerable to health disparities, including female sex workers, lesbian, gay, bisexual, and transgender women, women living with HIV, and women who use drugs. Yet characterization of the needs of these women is important, given their unique fertility-related concerns, including risks and barriers to care emanating from social stigmas and discrimination. This synthesis provides an overview of fertility-related evidence, highlighting where there are clear research gaps among marginalized women and the potential implications of these data shortfalls. Overall, research among marginalized women to date has addressed pregnancy prevention and in some cases fertility intentions, but the majority of studies have focused on postconception pregnancy safety and the well-being of the child. However, among female sex workers specifically, data on pregnancy safety and the well-being of the child are largely unavailable. Within each marginalized group, preconception care and effectiveness of conception methods are consistently understudied. Ultimately, the absence of epidemiologic, clinical and programmatic evidence limits the availability and quality of reproductive health services for all women and prevents social action to address these gaps.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Fertility-related research needs among women at the margins

Schwartz¹,

Baral

2015

Reproductive Health Matters

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“…While routine third-trimester testing is not recommended nationally, both BHIVA pregnancy guidelines [10] and RCOG guidelines [11] advocate considering thirdtrimester testing for those perceived to be at increased risk. This strategy was initially adopted with first-trimester testing, before the introduction of universal testing, and is known to have had inconsistencies in interpretation of which groups or individuals are at higher risk.…”

Section: Discussionmentioning

confidence: 99%

“…Current British HIV Association (BHIVA) guidelines 2012 [10] support the position of the UK national screening committee [5] which decided against recommending universal repeat third-trimester HIV testing, instead recommending that 'repeat tests could be offered to any woman who was thought to be at continuing risk of infection and to any woman who requested a second or subsequent test' . The Royal College of Obstetricians and Gynaecologists (RCOG) guidelines state that 'if a woman tests HIV negative at booking but is judged by her clinician as being at continued high risk of acquiring HIV, offering a repeat HIV test should be considered' [11].…”

Section: Introductionmentioning

confidence: 99%

“…It is not known what proportion seroconvert during the later stages of pregnancy rather than during breast feeding and hence would have HIV infection detected by routine thirdtrimester screening. It is also not known how many children born to mothers who seroconverted in pregnancy have undiagnosed HIV infection in the population.While routine third-trimester testing is not recommended nationally, both BHIVA pregnancy guidelines [10] and RCOG guidelines [11] advocate considering thirdtrimester testing for those perceived to be at increased risk. This strategy was initially adopted with first-trimester testing, before the introduction of universal testing, and is known to have had inconsistencies in interpretation of which groups or individuals are at higher risk.…”

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confidence: 99%

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Repeat antenatal HIV testing in the third trimester: a study of feasibility and maternal uptake rates

et al. 2013

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The study aimed to assess the feasibility and acceptability of third-trimester antenatal HIV testing within our service after two cases of HIV seroconversion in pregnancy were noted in 2008. North American Guidelines recommend universal third-trimester HIV testing in areas with an HIV prevalence of more than 1 per 1000. The HIV prevalence rate in our area is 3.01 per 1000. MethodsPregnant women prior to 28 weeks of gestation were recruited at booking between 1 September 2008 and 31 August 2009 and offered an additional third-trimester HIV test. Consent was obtained and testing was performed by hospital and community midwives. Information was entered into a modified existing electronic maternity database. A qualitative e-mail survey of midwives investigated barriers to participation in the study. ResultsA total of 4134 women delivered; three (< 0.1%) declined first-trimester testing. Twenty-two women (0.5%) tested HIV positive, of whom six were newly diagnosed. Overall, 2934 of 4134 women (71%) were offered and accepted a third-trimester HIV test and had results available. Data were unavailable for 195 women (4.7%). A total of 663 of 4131 women (16%) were not offered a third-trimester test. Of 3273 women documented as having been offered a test, 3177 (97.1%) accepted. There were no positive third-trimester tests. Forty of 50 (80%) midwives surveyed responded with questionnaire feedback and cited lack of national policy and extra workload as barriers to performing third-trimester testing. ConclusionsThird-trimester testing was feasible and consent rates were high in those offered repeat testing. Third-trimester testing has the potential to prevent paediatric HIV infection and universal testing should be considered in high-prevalence areas.Keywords: HIV testing, pregnancy, third trimester Accepted 1 October 2013 IntroductionFull adherence to national prevention of mother-to-child transmission of HIV guidelines has reduced the transmission rate from around 25% without intervention to less than 1% annually [1]. An audit exploring factors behind perinatal HIV transmission in 87 children between 2002 and 2005 concluded that around 70% were born to undiagnosed women and at least 20% of mothers had tested negative in pregnancy [2]. Thus, identifying seroconversion in pregnancy could help reduce mother-to-child HIV transmission further.US guidelines [3] recommend universal repeat thirdtrimester HIV screening for women receiving care in facilities where at least one HIV infection is diagnosed per 1000 pregnant women screened. In the last decade, approximately 1 in 250 women who booked with North West London Hospitals (NWLH) NHS Trust were HIV positive. In 2006, the perinatal HIV group at NWLH NHS trust observed two cases of HIV seroconversion in pregnancy. There is additionally one HIV-infected child in our service whose mother tested HIV negative in the first trimester of pregnancy and who reportedly mixed breast and bottle fed for 2 months after delivery.Following discussion among the Trust's multidisciplinary perinatal ...

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Drug monographs

2014

Neonatal Formulary 7

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British HIV Association guidelines for the management ofHIVinfection in pregnant women 2012

Cited by 106 publications

References 296 publications

Fertility-related research needs among women at the margins

Fertility-related research needs among women at the margins

Repeat antenatal HIV testing in the third trimester: a study of feasibility and maternal uptake rates

Drug monographs

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