Conclusions

If the promise of the ACTG 076 findings, that perinatal transmission of HIV can largely be prevented, is to be fulfilled, the United States needs to adopt a goal that all pregnant women be tested for HIV, and those who are positive remain in care so they can receive optimal treatment for themselves and their children. In order 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 (1) education of prenatal care providers; (2) the development and implementation of practice guidelines and the implementation of clinical policies: (3) the development and adoption of performance measures and Medicaid managed care contract language for prenatal HIV testing; (4) efforts to improve coordination of care and access to high-quality HIV treatment; (5) interventions to overcome pregnant women's concerns about HIV testing and treatment; (6) and efforts to increase utilization of prenatal care, as described above.



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