variability from state to state in the way that the PHS guidelines have been implemented, but no evidence to suggest that any particular approach is more successful than others in preventing perinatal HIV.

Starting with the current partial implementation of the PHS guidelines, the committee estimates that the most effective change would be to increase the number of women in prenatal care who are offered HIV testing by their providers and accept it. Increasing the rate at which providers offer HIV tests from 75% to 100%, and increasing the proportion of women who accept it from 80% to 100%, for instance, would reduce the number of HIV-infected babies by 33%—about 386 children per year. To reduce perinatally acquired HIV even further, efforts are needed to increase the availability and utilization of prenatal care, especially in women who use drugs; to improve the coordination and quality of health care for HIV-infected women; and to prevent HIV infection in women initially.



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