HIV Screening of Pregnant Women and Newborns (1991) / Chapter Skim
Currently Skimming:
7 Elements of a Prenatal HIV Screening
7 Elements of a Prenatal HIV Screening
Pages 49-60
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 49... ...
Therefore, the following discussion does -not provide an exhaustive review of screening program components but instead highlights those elements the committee judges to be of particular relevance and importance in prenatal HIV screening implementation. Education and Counseling Education and counseling before and after the administration of an HIV test should be regarded as essential components of a prenatal screening program.2 The pretest counseling session provides the foundation for an individual's informed consent, which, as noted earlier, should be secured in writing before testing is initiated.
|
From page 50... ...
During such counseling, the counselor has an opportunity to review the implications of HIV infection for her pregnancy, including the risks of transmitting the virus to her child and what is known about the possible effects of pregnancy on disease progression. Thorough examination of the reproductive options available to an HIV-infected pregnant woman is an important task of the pastiest counseling session.
|
From page 51... ...
Partner Involvement A recurring and fundamentally important theme during the committee's deliberations centered on the involvement of male partners in the HIV education and counseling process associated with prenatal screening. Changes in heterosexual couples' sexual practices and, in particular, condom use ultimately require the assent and cooperation of the male partner.
|
From page 52... ...
The diagnosis of HIV infection in a mother has important implications for the clinical management and appropriate medical follow-up of her child. The mother should be informed, during the pretest counseling session and in advance of any disclosure, of the importance of releasing her HIV test results to the pediatric caregiver, and she should be encouraged to do so to provide more effective medical management of her infant.
|
From page 53... ...
Constructing such a network of coordinated, Integrated, family-oriented medical and psychosocial support services can be a major challenge. To satisfy the myriad health and social needs of HIV-infected women and children requires a range of multidisciplinary medical care and social services: routine ambulatory care, such as immunologic surveillance and medical monitoring associated with antiretroviral therapy or prophylaxis against opportunistic infection; inpatient care; reproductive health care; day care; home care; substance abuse treatment; psychological support services; a variety of social services; and sometimes even housing and income support.
|
From page 54... ...
The committee decries the inherent inadequacies in the current health services delivery and financing system and recognizes that prenatal HIV screening may identify more women and children who need care than the system can currently accommodate. Nevertheless, it believes that the benefits of screening pregnant women for HIV infection in high-prevalence areas are sufficient to justify proceeding with program implementation, even though the present health and social services infrastructure may not be completely adequate.
|
From page 55... ...
If HIV screening for pregnant women is to achieve its goals, there must be some assurance that identified women and their children will not be denied access to needed health care by virtue of their infected status. The committee concludes that health care providers who offer HIV testing to their patients have an obligation to render appropriate treatment or to ensure that a referral is made and that such treatment is ultimately received.
|
From page 56... ...
Laboratory Services The availability of high~uality laboratory facilities and qualified technicians to perform the HIV serologic test series on collected blood specimens is critical to a successful screening program. Standardized quality assurance in laboratory performance is particularly important to ensure testing accuracy, that is, to minimize false-positive and falsenegative test results, as well as to resolve indeterminate test outcomes.
|
From page 57... ...
This ability to adjust program objectives and design is particularly important for HIV screening, given that diagnostic technology and medical therapy continue to evolve. A thorough review of program evaluation design and methodology Is beyond the scope of this report.6 Rather, the committee has chosen to hi~hlinh' con - ro1 acnPrtc of ~v~lil~tinn anti to identi~v the screening program elements that it deemed important to consider when planning and x&~ ~_~_~^ ~__w ~^ ~ _J Estates may spelt guidance in monitoring laboratory quality assurance and performance from CDC's Model Performance Evaluation Program, which was developed to assess and improve the analytic quality of HIV-antibody testing.
|
From page 58... ...
the overall effectiveness of pretest education and counseling~for instance, how well-informed women are with regard to HIV infection, risk behaviors, and the antibody test and its clinical and social implications; (4) the psychological and behavioral impacts of HIV testing and counseling (particularly pastiest counseling)
|
From page 59... ...
· Effect of the screening program on the delivery of other health services or programs-for instance, whether funds to support screening have been reprogrammed or diverted from other needed service programs, producing a deleterious impact on them. · Extent of health care provider compliance with the HIV screening standard of medical practice (i.e., prenatal HIV screening recommendations)
|
From page 60... ...
The committee recognizes the considerable resources, talent, and effort that mu be required to plan and conduct a thorough screening program evaluation. Because prenatal HIV screening programs have national relevance and importance, the committee concludes that federal support, in the form of additional funds specifically earmarked for evaluation, is nealed to ensure careful monitoring and assessment of program effects.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.