This figure depicts the analytic framework, which outlines the evidence areas covered in the review, including populations, screening, testing, interventions, and outcomes. The population includes pregnant women who are asymptomatic for HIV and screened in settings generalizable to primary care. There is an initial branch in the framework that splits pregnant women into low-risk or high-risk groups after screening, where key question 2a assesses the yield (number of new diagnoses) of repeat HIV screening. Then after HIV testing, the framework further splits patients into HIV positive and negative antibody groups. Harms of rapid versus standard HIV testing are assessed in key question 2b. A subsequent branch splits the framework into those with low CD4 counts or high viral loads and those with high CD4 counts and low viral loads. Key question 3a then assesses the effectiveness of newer antiretroviral regimens for reducing mother-to-child transmission, and key question 3b assesses the effects of antiretroviral regimens in pregnant, HIV-positive women on long-term maternal morbidity, mortality, or quality of life. An arrow from the interventions assesses the harms, including longer-term harms, to the mother or child associated with antiretroviral therapy during pregnancy (key question 3c). Intermediate outcomes of the interventions are improved CD4 counts, viremia, decreased risky behaviors, and future reproductive behaviors. Clinical health outcomes include reduced premature death and disability for women and children, and reduced mother-to-child transmission. An overarching arrow from screening to the clinical health outcomes addresses key question 1. A dotted line between the intermediate and clinical health outcomes represents the association between intermediate and clinical health outcomes.

FigureAnalytic Framework for Screening for HIV in Pregnant Women

Key Questions

1. What are the benefits of HIV screening versus no screening in asymptomatic pregnant women on maternal or child morbidity, mortality, or quality of life or rates of mother-to-child transmission?

2a. What is the yield (number of new diagnoses) of repeat HIV screening in asymptomatic pregnant women?

2b. What are the adverse effects (including false-positive results and anxiety) of rapid versus standard HIV testing in asymptomatic pregnant women?

3a. What is the effectiveness of newer antiretroviral regimens for reducing mother-to-child transmission?

3b. What are the effects of antiretroviral regimens in pregnant, HIV-positive women on long-term maternal morbidity, mortality, or quality of life?

3c. What are the harms (including longer-term harms) to the mother or child associated with antiretroviral therapy during pregnancy?

From: 2, METHODS

Cover of Screening for HIV in Pregnant Women: Systematic Review to Update the U.S. Preventive Services Task Force Recommendation
Screening for HIV in Pregnant Women: Systematic Review to Update the U.S. Preventive Services Task Force Recommendation [Internet].
Evidence Syntheses, No. 96.
Chou R, Cantor A, Bougatsos C, et al.

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