Investigating the decision-making needs of HIV-positive women in Africa using the Ottawa Decision-Support Framework: Knowledge gaps and opportunities for intervention Marion Doull a, * , Annette O’Connor b , M.J. Jacobsen b , Vivian Robinson a , Laura Cook c , Caroline Nyamai-Kisia d , Peter Tugwell a a Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Canada K1N 6N5 b University of Ottawa and Ottawa Health Research Institute, Ottawa, Canada c Arthritis Community Research and Evaluation Unit, Division of Outcomes and Population Health, Toronto Western Hospital Research Institute, Toronto, Canada d AfriAfya, Harnessing ICTs for Health, Nairobi, Kenya Received 22 February 2006; received in revised form 22 June 2006; accepted 29 June 2006 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. Conclusion: 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. Practice implications: Incorporating a multi-disciplinary decision-support framework may prove useful to promote women’s autonomy and involvement in MTCT-related decision making. # 2006 Elsevier Ireland Ltd. All rights reserved. Keywords: HIV/AIDS; Pregnancy; Decision making; Reproductive health 1. Introduction Research has consistently shown that maternal health and well-being are crucial to child health and survival in the developing world. However, this knowledge has not resulted in consistent and equitable treatment and care for HIV- positive women. HIV-positive pregnant women are often seen as mothers first rather than individuals in their own right. This paper will examine HIV-positive women’s decision making in the context of pregnancy and HIV/ AIDS and will explore interventions that may enhance and develop women’s decision-making capacity in this arena. It is believed that women themselves are an underused resource in their care and treatment and that decision- support interventions such as ‘health coaching’ may help to capitalize on women’s unique knowledge and skills. The Health Coach approach is a shared decision-making style of counselling based on the Ottawa Decision-Support www.elsevier.com/locate/pateducou Patient Education and Counseling 63 (2006) 279–291 * Corresponding author. Tel.: +1 613 562 5800x2509; fax: +1 613 562 5659. E-mail address: mdoull@uottawa.ca (M. Doull). 0738-3991/$ – see front matter # 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2006.06.020