The following press release from the Institute of Medicine concerning
HIV and pregnant women is provided to you as a public service of the CDC
National Center for HIV, STD and TB Prevention. The full report and
background documents may be obtained from the World Wide Web at
www2.nas.edu.
Date: Oct. 14, 1998
Contacts: Dan Quinn, Media Relations Officer
David Schneier, Media Relations Assistant
(202) 334-2138; e-mail news@nas.edu
Number of Children With AIDS Still Unacceptably High; Routine HIV
Testing Needed in Prenatal Care
WASHINGTON -- Testing for the human immunodeficiency virus (HIV) should
be a routine part of prenatal care, according to a new report from a
committee of the Institute of Medicine. Health care providers should
notify women that HIV testing is part of the usual array of prenatal
tests and women should have an opportunity to refuse. This approach
could help reduce the number of pediatric AIDS cases and improve
treatment for mothers with AIDS.
Current federal guidelines were put in place after discovery in 1994 of
a new therapy that reduces by two-thirds the chance that an infected
woman will pass HIV to her child. The guidelines advise health care
providers to give extensive pre-test counseling to all pregnant women,
educating them about the risks of AIDS and the benefits of being tested.
These guidelines led to an increase in testing and treatment. But
because many women are not tested and do not receive treatment, the
number of children born with HIV is still unacceptably high, the report
says.
"We have the tools to prevent HIV infection in newborns. Now we must get
treatment to everyone who needs it," said committee chair Marie
McCormick, professor and chair, department of maternal and child health,
Harvard School of Public Health, Boston. "By making HIV screening a
routine part of prenatal care for all pregnant women, regardless of
their risk factors or where they live, we can further lower the number
of pediatric AIDS cases and help infected women get high-quality
treatment."
Making prenatal testing routine would help lower many of the barriers
that keep women from being tested. It would reduce the burden on
prenatal care givers to provide the extensive pre-test counseling
required by current guidelines. Providers would no longer have to decide
whether to encourage some women more than others to be tested, an
approach that results in many cases being missed. It would lessen the
stigmatization of groups in which perinatal HIV transmission is now more
prevalent, which include African American and Hispanic women. And it
would guard against geographic shifts in the incidence of HIV infection,
which is more common among women in large cities and in parts of the
northeastern and southern United States. The costs of routine prenatal
testing compare favorably with the costs of treating children who have
HIV.
The committee outlined a series of steps to support routine testing in
prenatal care, and to meet the needs of pregnant women and health care
providers. 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
practice guidelines to recommend such testing. Providers need to be
educated about the value of prenatal HIV screening, and how to deal
appropriately with those who test positive. And health officials need to
improve their outreach to pregnant women, to address concerns about
testing and treatment.
Testing should be seamlessly linked to treatment for women found to be
infected, and this care must be coordinated before, during, and after
delivery, the report says. Providers must take steps, however, to ensure
that their patient's confidentiality is protected, and that they are not
forced into taking a test if they object.
Effective Treatment
Researchers determined in 1994 that administering the drug zidovudine
(ZDV, formerly known as AZT) during pregnancy and childbirth could
reduce by two-thirds the chance that a mother infected with HIV would
give birth to an infected child. The finding was one of the most
important since the beginning of the AIDS epidemic, because 6,000 to
7,000 HIV-infected women in the United States give birth each year.
After the initial research findings were announced in 1994, federal
agencies, most states, and a number of professional organizations
instituted policies, legislation, and guidelines to encourage HIV
testing for pregnant women. As a result of ZDV treatment and other
factors, the number of new pediatric AIDS cases dropped by about 43
percent between 1992 and 1996.
It is critical that federal funding for state and local efforts to
prevent perinatal HIV transmission be maintained, the report says. The
committee was not asked to take a position on mandatory testing of all
newborns, but noted that such testing can only play a limited role in
preventing transmission of HIV from mother to child. Under the current
provisions of the Ryan White Comprehensive AIDS Resources Emergency Act
Amendments of 1996, federal funds for states could become contingent
upon mandatory testing of newborns. If funds that could be used for
prevention are directed toward newborn testing, the federal government
could actually undermine efforts to keep infants from contracting the
virus.
To boost prevention efforts, the federal government should establish a
regional system of perinatal HIV prevention and treatment centers. These
centers would help assure optimal HIV care for all pregnant women and
newborns, and would help develop and implement strategies to improve HIV
testing in prenatal care. Federal, state, and local public health
agencies also should maintain appropriate surveillance data on
HIV-infected women and children, the report says.
A committee roster follows. This study was funded by the U.S. Department
of Health and Human Services. The Institute of Medicine is a private,
non-profit organization that provides health policy advice under a
congressional charter granted to the National Academy of Sciences.
________________________________________________________________________
*Pre-publication copies of Reducing the Odds: Preventing Perinatal
Transmission of HIV in the United States are available from the National
Academy Press at the mailing address in the letterhead; tel. (202)
334-3313 or 1-800-624-6242. The cost of the report is $48.95 (prepaid)
plus shipping charges of $4.00 for the first copy and $.50 for each
additional copy. Reporters may obtain a copy from the Office of News and
Public Information at the letterhead address (contacts listed above).
This news release is available on the World Wide Web at
nas.edu
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