Nakchbandi I A, Longenecker J C, Ricksecker M A, Latta R A, Healton C, Smith D G
Abington Memorial Hospital, Pennsylvania 19001, USA.
Ann Intern Med. 1998 May 1;128(9):760-7. doi: 10.7326/0003-4819-128-9-199805010-00010.
The benefit of antiretroviral therapy in reducing maternal-fetal transmission of HIV during pregnancy has caused a public policy debate about the relative benefits of mandatory HIV screening and voluntary HIV screening in pregnant women.
To evaluate the benefits and risks of mandatory compared with voluntary HIV testing of pregnant women to help guide research and policy.
A decision analysis that incorporated the following variables: acceptance and benefit of prenatal care, acceptance and benefit of zidovudine therapy in HIV-infected women, prevalence of HIV infection, and mandatory compared with voluntary HIV testing.
The threshold deterrence rate (defined as the percentage of women who, if deterred from seeking prenatal care because of a mandatory HIV testing policy, would offset the benefit of zidovudine in reducing vertical HIV transmission) and the difference between a policy of mandatory testing and a policy of voluntary testing in the absolute number of HIV-infected infants or dead infants.
Voluntary HIV testing was preferred over a broad range of values in the model. At baseline, the threshold deterrence rate was 0.4%. At a deterrence rate of 0.5%, the number of infants (n = 167) spared HIV infection annually in the United States under a mandatory HIV testing policy would be lower than the number of perinatal deaths (n = 189) caused by lack of prenatal care.
The most important variables in the model were voluntary HIV testing, the deterrence rate associated with mandatory testing compared with voluntary testing, and the prevalence of HIV infection in women of child-bearing age. At high levels of acceptance of voluntary HIV testing, the benefits of a policy of mandatory testing are minimal and may create the potential harms of avoiding prenatal care to avoid mandatory testing.
抗逆转录病毒疗法在降低孕期人类免疫缺陷病毒（HIV）母婴传播方面的益处引发了一场关于孕妇强制HIV筛查和自愿HIV筛查相对益处的公共政策辩论。
评估孕妇强制HIV检测与自愿HIV检测相比的益处和风险，以帮助指导研究和政策制定。
一项决策分析，纳入以下变量：产前护理的接受度和益处、齐多夫定疗法在HIV感染女性中的接受度和益处、HIV感染率，以及强制HIV检测与自愿HIV检测的比较。
阈值威慑率（定义为因强制HIV检测政策而被阻止寻求产前护理的女性百分比，该百分比将抵消齐多夫定在降低HIV垂直传播方面的益处），以及强制检测政策与自愿检测政策在HIV感染婴儿或死亡婴儿绝对数量上的差异。
在模型的广泛取值范围内，自愿HIV检测更受青睐。在基线时，阈值威慑率为0.4%。在威慑率为0.5%时，在美国强制HIV检测政策下每年免于感染HIV的婴儿数量（n = 167）将低于因缺乏产前护理导致的围产期死亡数量（n = 189）。
该模型中最重要的变量是自愿HIV检测、强制检测与自愿检测相关的威慑率，以及育龄女性中的HIV感染率。在自愿HIV检测接受度较高的情况下，强制检测政策的益处微乎其微，且可能产生为避免强制检测而放弃产前护理的潜在危害。
