WASHINGTONHIV testing should be made a routine but voluntary
part of prenatal care for all women in the United States, an
Institute of Medicine (IOM) committee has recommended.
We believe that health care providers should notify pregnant
women that HIV is part of the usual array of tests they will receive,
and women should have the opportunity to refuse the test, said
panel chair Marie McCormick, MD, ScD, professor of maternal and child
health, Harvard School of Public Health. This subtle yet
important shift in policy would help reduce the number of pediatric
AIDS cases and, as long as it happens in parallel with good medical
care, would also improve treatment for mothers with AIDS.
Women now account for 21% of adult AIDS cases in the United States.
The IOM report noted that the use of zidovudine (AZT, Retrovir) in
HIV-infected pregnant women had a major role in helping reduce the
number of new pediatric AIDS cases by 43% between 1992 and 1996.
Clinical trials have shown that zidovudine can reduce mother-to-child
HIV transmission rates to below 5%. About 500 babies will be born
this year with full-blown AIDS and as many as 1,500 more with HIV infection.
Making HIV testing routine would reduce the need to provide extensive
pre-test counseling required by current guidelines, Dr. McCormick
said. It would also end the need for doctors to assess whether a
women is at high risk of infection and make extra efforts to
encourage high-risk women to be tested.
By recognizing that HIV is a communicable disease without
inherent geographic or human barriers, routine testing would lessen
the stigmatization of groups in which perinatal HIV transmission is
now more prevalent, she added.
An analysis showed that the cost of this policy recommendation
compares favorably with the cost of treating HIV-infected children.
The panel also urged that the federal government establish a regional
system of perinatal HIV prevention and treatment centers. These
centers would help ensure optimal HIV care for all pregnant women and
newborns, and would help develop and implement strategies to promote
prenatal HIV screening, she said.
The IOM report, Reducing The Odds: Preventing Perinatal
Transmission of HIV in the United States, proposed six actions
needed to make its testing recommendation a reality:
Health care plans should implement policies to facilitate routine
prenatal testing, and should track their success in conducting HIV screening.
- Businesses and other organizations that
purchase health care should support routine prenatal testing in their
contracts with providers.
- Professional medical organizations should
update their guidelines to recommend routine prenatal screening.
- Providers need to be educated about the value
of prenatal HIV screening and how to deal appropriately with those
who test positive.
- Health officials need to improve their
outreach to pregnant women, to address their concerns about testing
- Testing should be seamlessly linked to
treatment for women found to be infected, and this care must be
coordinated before, during, and after delivery. Providers must take
steps to ensure their patients confidentiality is protected,
and that a patient is not forced to take a test.
We are saying that the process for identifying HIV should be so
routine, with informed consent, that it is likely to be universally
available, said panel vice chair Ezra Davidson, Jr., MD,
professor of ob/gyn, Charles R. Drew University of Medicine and
Science, Los Angeles.