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Abstract：
High maternal HIV incidence contributes substantially to mother-to-child HIV transmission (MTCT) in some settings. Since 2006, HIV retesting during the third trimester and breastfeeding has been recommended by the World Health Organization in higher prevalence (≥5%) settings to reduce MTCT. However, many countries lack clarity on when and how often to retest pregnant and postpartum women to optimize resources and service delivery. We reviewed and characterized national guidelines on maternal retesting based on timing and frequency.
We identified 52 countries to represent variations in HIV prevalence, geography, and MTCT priority and searched available national MTCT, HIV testing and HIV treatment policies published between 2007 and 2017 for recommendations on retesting during pregnancy, labour/delivery and postpartum. Recommended retesting frequency and timing was extracted. Country HIV prevalence was classified as: very low (<1%), low (1% to 5%), intermediate (>5 to <15%) and high (≥15%). Women with unknown HIV status at delivery/postpartum were included in retesting guidelines.
Overall, policies from 49 countries were identified; 51% from 2015 or later and most (n = 25) were from Africa. Four countries were high HIV prevalence, seven intermediate, sixteen low and twenty-two very low. Most (n = 31) had guidance on universal voluntary opt-out HIV testing at the first antenatal care (ANC) visit. Beyond the first ANC visit, the majority (78%, n = 38) had guidance on retesting; 22 recommended retesting all women with unknown/negative status, five only if unknown HIV status, three in pregnancy based on risk and eight combining these approaches. Retesting was universally recommended during pregnancy, labour/delivery, and postpartum for all high prevalence settings and four of seven intermediate prevalence settings. Five UNAIDS priority countries for EMTCT with low/very low HIV prevalence, but high/intermediate MTCT, had no guidance on retesting.
Retesting guidelines for pregnant and postpartum women were ubiquitous in high prevalence countries and defined in some intermediate prevalence countries, but absent in some low HIV prevalence countries with high MTCT. Countries may require additional guidance on how to optimize maternal HIV testing and whether to prioritize retesting efforts or discontinue universal retesting based on HIV incidence. Research is needed to assess country-level guideline implementation and impact.
We identified 52 countries to represent variations in HIV prevalence, geography, and MTCT priority and searched available national MTCT, HIV testing and HIV treatment policies published between 2007 and 2017 for recommendations on retesting during pregnancy, labour/delivery and postpartum. Recommended retesting frequency and timing was extracted. Country HIV prevalence was classified as: very low (<1%), low (1% to 5%), intermediate (>5 to <15%) and high (≥15%). Women with unknown HIV status at delivery/postpartum were included in retesting guidelines.
Overall, policies from 49 countries were identified; 51% from 2015 or later and most (n = 25) were from Africa. Four countries were high HIV prevalence, seven intermediate, sixteen low and twenty-two very low. Most (n = 31) had guidance on universal voluntary opt-out HIV testing at the first antenatal care (ANC) visit. Beyond the first ANC visit, the majority (78%, n = 38) had guidance on retesting; 22 recommended retesting all women with unknown/negative status, five only if unknown HIV status, three in pregnancy based on risk and eight combining these approaches. Retesting was universally recommended during pregnancy, labour/delivery, and postpartum for all high prevalence settings and four of seven intermediate prevalence settings. Five UNAIDS priority countries for EMTCT with low/very low HIV prevalence, but high/intermediate MTCT, had no guidance on retesting.
Retesting guidelines for pregnant and postpartum women were ubiquitous in high prevalence countries and defined in some intermediate prevalence countries, but absent in some low HIV prevalence countries with high MTCT. Countries may require additional guidance on how to optimize maternal HIV testing and whether to prioritize retesting efforts or discontinue universal retesting based on HIV incidence. Research is needed to assess country-level guideline implementation and impact.
摘要：
在某些情况下，高孕产妇艾滋病毒发病率在很大程度上促进了母婴艾滋病毒传播（MTCT）。自2006年以来，世界卫生组织建议在妊娠晚期和母乳喂养期间进行HIV再检测，以降低MTCT的患病率（≥5％）。然而,许多国家不清楚何时以及多久对孕妇和产后妇女进行复检，以优化资源和服务提供。我们根据时间和频率审查并描述了有关孕产妇复检的国家指南。
我们确定了52个国家代表艾滋病毒流行率的变化，地理,和MTCT优先级，并搜索可用的国家MTCT，2007年至2017年期间发布的艾滋病毒检测和艾滋病毒治疗政策，建议在怀孕期间重新检测。分娩/分娩和产后。提取了推荐的重新测试频率和时间。国家艾滋病毒感染率被分类为：非常低(<1%)，低（1%至5%），中等(>5至<15%)和高(≥15%)。分娩/产后HIV感染状况未知的妇女被纳入复检指南。
总的来说，确定了来自49个国家的政策；2015年或更晚的51％，大多数（n=25）来自非洲。四个国家的艾滋病毒感染率很高，七个中间，十六低和二十二非常低。大多数（n=31）在第一次产前护理（ANC）访问中都有关于普遍自愿选择退出HIV检测的指导。除了第一次ANC访问之外，大多数（78%，n=38）有重新测试的指导；22建议重新测试所有未知/阴性状态的妇女，只有在未知艾滋病毒状况的情况下，三个基于风险的怀孕和八个结合这些方法。怀孕期间普遍建议复检，劳动力/交付，和产后所有高患病率设置和七个中间患病率设置中的四个。艾滋病毒流行率低/非常低的五个艾滋病方案优先国家，但是高/中MTCT，没有重新测试的指导。
孕妇和产后妇女复检指南在高患病率国家普遍存在，在一些中等患病率国家也有定义。但在一些HIV感染率较高的国家却没有MTCT。各国可能需要关于如何优化孕产妇艾滋病毒检测以及是否优先考虑重新检测工作或停止基于艾滋病毒发病率的普遍重新检测的额外指导。需要进行研究以评估国家一级的准则执行情况和影响。
我们确定了52个国家代表艾滋病毒流行率的变化，地理,和MTCT优先级，并搜索可用的国家MTCT，2007年至2017年期间发布的艾滋病毒检测和艾滋病毒治疗政策，建议在怀孕期间重新检测。分娩/分娩和产后。提取了推荐的重新测试频率和时间。国家艾滋病毒感染率被分类为：非常低(<1%)，低（1%至5%），中等(>5至<15%)和高(≥15%)。分娩/产后HIV感染状况未知的妇女被纳入复检指南。
总的来说，确定了来自49个国家的政策；2015年或更晚的51％，大多数（n=25）来自非洲。四个国家的艾滋病毒感染率很高，七个中间，十六低和二十二非常低。大多数（n=31）在第一次产前护理（ANC）访问中都有关于普遍自愿选择退出HIV检测的指导。除了第一次ANC访问之外，大多数（78%，n=38）有重新测试的指导；22建议重新测试所有未知/阴性状态的妇女，只有在未知艾滋病毒状况的情况下，三个基于风险的怀孕和八个结合这些方法。怀孕期间普遍建议复检，劳动力/交付，和产后所有高患病率设置和七个中间患病率设置中的四个。艾滋病毒流行率低/非常低的五个艾滋病方案优先国家，但是高/中MTCT，没有重新测试的指导。
孕妇和产后妇女复检指南在高患病率国家普遍存在，在一些中等患病率国家也有定义。但在一些HIV感染率较高的国家却没有MTCT。各国可能需要关于如何优化孕产妇艾滋病毒检测以及是否优先考虑重新检测工作或停止基于艾滋病毒发病率的普遍重新检测的额外指导。需要进行研究以评估国家一级的准则执行情况和影响。
