centers for specialized treatment of HIV-infected women and affected children, and to a lesser extent, for coordination of prevention activities. There is, however, no coordinated, regional approach. Thus,

The committee recommends that a regional system of perinatal HIV prevention and treatment centers be established.

The regional centers would help to assure optimal HIV care for all pregnant women and newborns, directly to those referred to the centers, and indirectly by working with primary care physicians who retain responsibility for the medical care of HIV-infected women. Moving beyond current practices, the regional centers would also help to develop and implement strategies to improve HIV testing in prenatal care, as discussed above.

Defining the organization, funding, and operations of the recommended regional approach is beyond the scope of this report. To advance this plan, HRSA's Bureau of HIV/AIDS and its Maternal and Child Health Bureau, which together have authority and funding to deal with prenatal care and HIV treatment, should convene a national working group to implement this regional approach. The members of the working group should include representatives of CDC for their prevention authority, National Institutes of Health (NIH) because many of the existing centers receive significant research funding, and Health Care Financing Administration (HCFA) because of its oversight of Medicaid. State and local health authorities, representatives of managed care organizations, and representatives of the prenatal care providers should also be involved.

Surveillance

Surveillance systems are needed to support policy development and program evaluation regarding perinatal transmission of HIV. Thus, in order to support the previous recommendation about performance measures, and to generally guide prevention efforts,

The committee recommends that federal, state, and local public health agencies maintain appropriate surveillance data on HIV-infected women and children as an essential component of national efforts to prevent perinatal transmission of HIV.

The universal testing approach that the committee recommends, as well as the call for health plan performance measures, should facilitate the development of appropriate public health surveillance systems.



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