sites and 63% to 95% of women offered an HIV test actually had the test performed (Appendix D).

The evidence indicates that very high rates of HIV test acceptance are feasible within voluntary programs. Nearly nine of ten pregnant women (86%) are tested prenatally for HIV in Texas according to preliminary data from the state's 1997 birth certificates, which record whether a woman was tested prenatally and at delivery (Mitchell, 1998). Since 1995, Texas has required all prenatal care providers to test every pregnant woman for HIV, unless the woman refuses.

Other states that are monitoring perinatal HIV test use have relatively low prenatal testing rates. While virtually all newborns are tested following the implementation of New York State's mandated newborn HIV screening program, only 48% of pregnant women were tested prenatally in 1997 (Birkhead, 1998). According to analyses of laboratory data, an estimated 56% of pregnant women received prenatal HIV testing in Hawaii from April 1997 to March 1998 (Partika, 1998).

Providers Offering ZDV Treatment, Women Accepting and Complying with the Recommended ZDV Treatment Regimen

As discussed in Chapter 4, once an HIV-infected pregnant women has been identified, health care providers need to be familiar with PHS treatment recommendations (CDC, 1998d), offer the treatment to women, and monitor compliance and potential side effects of therapy throughout pregnancy, labor, and the postpartum period. The actual recommended ZDV regimen is complex insofar as it is fairly intensive, there is uncertainty regarding long-term effects, administration involves coordination across providers and sites (e.g., obstetric and pediatric personnel, outpatient and inpatient services), and may be associated with side effects and complications that require monitoring.

Compliance with the ACTG 076 regimen involves women taking an oral dose of ZDV five times daily2 starting at 14 to 34 weeks of gestation and continuing throughout her pregnancy. During labor, providers need to ensure that ZDV is administered intravenously, and after birth, newborns need to be given an oral dose of ZDV syrup every six hours for the first six weeks of life, beginning eight to twelve hours after birth (CDC, 1994). This regimen was followed as part of the ACTG 076 trial, but clinicians need to use their judgment and consider calling upon experts for advice when their patients do not fit the profile of the women enrolled in the clinical trial (e.g., those with a history of extensive ZDV therapy before pregnancy). Providers also need to conduct special tests monthly to assess potential adverse effects of ZDV.

2  

More recent data indicate that transmission reduction can be accomplished with fewer daily ZDV doses (CDC, 1998e).



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