title: Investigating the decision-making needs of HIV-positive women in Africa using the Ottawa Decision-Support Framework: Knowledge gaps and opportunities for intervention.
abstract: OBJECTIVE
  To examine HIV-positive women's decision making in the context of pregnancy and HIV/AIDS and to explore interventions that may enhance and develop women's decision-making capacity in the sub-Saharan African context.
  
  
  METHODS
  The Ottawa Decision-Support Framework was used to assemble evidence of women's decision-making needs. Several electronic databases were searched and an Internet search of the World Wide Web was conducted to search grey literature sources. An evidence-based approach to assessing benefits, harms and current practices was employed.
  
  
  RESULTS
  Several gaps in our knowledge about women's decision making in the context of pregnancy and HIV were identified. The availability of evidence varied for each decision; however, significant gaps included: evidence around testing for ones status, advanced directives for self and child, disclosure (specifically, the impact of), others perceptions of antiretroviral use and data on termination of pregnancies.
  
  
  CONCLUSIONS
  Decision making as a concept was generally not addressed in the MTCT literature. Evidence regarding the perceptions of women and others regarding the various decisions was often not available and subsequently an important aspect of MTCT interventions neglected.
  
  
  CONCLUSIONS
  Incorporating a multi-disciplinary decision-support framework may prove useful to promote women's autonomy and involvement in MTCT-related decision making.
authors.affiliation: Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Canada. mdoull@uottawa.ca
authors.forename: Marion
authors.initials: M
authors.lastname: Doull
authors.forename: Annette
authors.initials: A
authors.lastname: O'Connor
authors.forename: M J
authors.initials: MJ
authors.lastname: Jacobsen
authors.forename: Vivian
authors.initials: V
authors.lastname: Robinson
authors.forename: Laura
authors.initials: L
authors.lastname: Cook
authors.forename: Caroline
authors.initials: C
authors.lastname: Nyamai-Kisia
authors.forename: Peter
authors.initials: P
authors.lastname: Tugwell
mesh_terms: D017954:Africa South of the Sahara; D003376:Counseling; D003657:Decision Making; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D020380:Needs Assessment; D011247:Pregnancy / Q000523:psychology; D034121:Reproductive Health Services