care providers about the value of universal HIV testing and about avenues of referral for patients who test positive.

Improved Provider Practices

A variety of specific clinical policies facilitate HIV testing, such as inclusion of HIV tests in the standard prenatal test panel and no longer requiring counseling as a prerequisite for HIV testing. In particular,

The committee recommends that professional organizations update their clinical practice guidelines to facilitate universal HIV testing, with patient notification, as a routine component of prenatal care.

In addition to their direct influence on clinical practices, guidelines of this sort issued by professional organizations have an important role to play in determining the standard of care.

In addition,

The committee recommends that all health care plans and providers develop, adopt, and evaluate clinical policies to facilitate universal prenatal HIV testing.

Clinical policies to implement the committee's recommendation for universal, routine testing with patient notification might include, for example, the inclusion of an HIV test on the checklist of clinical tests for which blood is drawn at the first prenatal visit, standing orders, and procedures to ensure that positive test results are delivered in a timely and appropriate way.

Performance Measures and Contract Language

Health care plans and providers increasingly are being held accountable for the services they provide through performance indicators in such areas as cost, quality of care, and patient satisfaction. In order to take advantage of this approach,

The committee recommends that health care plans and providers adopt performance measures for a policy of universal HIV testing, with patient notification, as a routine component of prenatal care.

To implement this recommendation, groups that develop performance measures, such as the National Committee for Quality Assurance (NCQA), should develop and adopt specific performance indicators for prenatal testing. Given the committee's emphasis on universal HIV testing as a routine component of prenatal



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