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PREVENTING PERINATAL TRANSMISSION OF HUMAN IMMUNODEFICIENCY VIRUS IN THE UNITED STATES

McCormick, Marie C. MD, ScD; Davidson, Ezra C. Jr MD; Stoto, Michael A. PhD

Clinical Commentary

Prenatal human immunodeficiency virus (HIV) testing and treatment instituted in the 1990s is responsible for a substantial reduction in the number of children diagnosed with AIDS, yet the number of children born with HIV infection remains unacceptably high. To prevent perinatal transmission of HIV, the United States must adopt a goal to test all pregnant women for HIV and to provide optimal treatment for women who test positive and their children. To meet this goal, the United States should adopt a national policy of universal HIV testing with patient notification as a routine component of prenatal care. Adopting this policy will require the establishment of, and resources for, a comprehensive infrastructure. This infrastructure must include education of prenatal care providers, the development and implementation of practice guidelines and the implementation of clinical policies, the development and adoption of performance measures and Medicaid managed care contract language for prenatal HIV testing, efforts to improve coordination of care and access to high-quality HIV treatment, interventions to overcome pregnant women's concerns about HIV testing and treatment, and efforts to increase use of prenatal care, as described above.

To prevent perinatal transmission of human immunodeficiency virus, the United States should adopt universal human immunodeficiency virus testing with patient notification as a routine component of prenatal care.

Harvard School of Public Health, Boston, Massachusetts; Charles R. Drew University of Medicine and Science, Los Angeles, California; and the Institute of Medicine and the George Washington University School of Public Health and Health Services, Washington, DC.

Address reprint requests to: Michael Stoto, PhD, Institute of Medicine, 2101 Constitution Avenue, NW, Washington, DC 20418; E-mail: sphmas@gwumc.edu

The project on which this article is based was requested by the Congress, and the Department of Health and Human Services provided financial support. Members of the Committee on Perinatal Transmission of HIV include Marie McCormick (chair), Ezra C. Davidson, Jr, (vice-chair), Fred Battaglia, Ronald Brookmeyer, Deborah Cotton, Susan Cu-Uvin, Nancy Kass, Patricia King, Lorraine Klerman, Katherine Ruiz de Luzuriaga, Ellen Mangione, Stephen Thomas, and Sten Vermund. Members of the Institute of Medicine staff include Michael A. Stoto and Donna A. Almario.

Received March 8, 1999. Received in revised form July 28, 1999. Accepted August 5, 1999.

© 1999 The American College of Obstetricians and Gynecologists