Background: Effective interventions to prevent mother-to-child HIV transmission (PMTCT) exist and when properly\r\napplied reduce the risk of vertical HIV transmission. As part of optimizing PMTCT in the Dutch Caribbean we\r\ndeveloped a set of valid and applicable indicators in order to assess the quality of care in HIV-infected (pregnant)\r\nwomen and their newborns.\r\nMethods: A multidisciplinary expert panel of 19 experts reviewed and prioritized recommendations extracted from\r\nlocally used international PMTCT guidelines according to a 3-step-modified-Delphi procedure. Subsequently, the\r\nfeasibility, sample size, inter-observer reliability, sensitivity to change and case mixed stability of the potential\r\nindicators were tested for a data set of 153 HIV-infected women, 108 pregnancies of HIV-infected women and 79\r\nnewborns of HIV-infected women in Aruba, CuraÃ?§ao and St Maarten from 2000 to 2010.\r\nResults: The panel selected and prioritized 13 potential indicators. Applicability could not be tested for 4 indicators\r\nregarding HIV-screening in pregnant women because of lack of data. Four indicators performed satisfactorily for\r\nCuraÃ?§ao (ââ?¬â?¢monitoring CD4-cell countââ?¬â?¢, ââ?¬Ë?monitoring HIV-RNA levelsââ?¬â?¢, ââ?¬Ë?intrapartum antiretroviral therapy and infant\r\nprophylaxis if antepartum antiretroviral therapy was not receivedââ?¬â?¢, ââ?¬Ë?scheduled caesarean deliveryââ?¬â?¢) and 3 for St\r\nMaarten (ââ?¬â?¢monitoring CD4-cell countââ?¬â?¢, ââ?¬Ë?monitoring HIV-RNA levelsââ?¬â?¢, ââ?¬Ë?discuss and provide combined antiretroviral\r\ntherapy to all HIV-infected pregnant womenââ?¬â?¢) whilst none for Aruba.\r\nConclusions: A systemic evidence-and consensus-based approach was used to develop quality indicators in 3\r\nDutch Caribbean settings. The varying results of the applicability testing accentuate the necessity of applicability\r\ntesting even in, at first, comparable settings.
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