[Federal Register: October 31, 2000 (Volume 65, Number 211)]
[Notices]
[Page 65242-65243]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr31oc00-122]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
Draft Guidelines for Revised U.S. Public Health Service
Recommendations for Human Immunodeficiency Virus (HIV) Screening of
Pregnant Women
AGENCY: Centers for Disease Control and Prevention (CDC), Department of
Health and Human Services (HHS).
ACTION: Notice and Request for Comments.
-----------------------------------------------------------------------
SUMMARY: This notice announces the availability for public comment of a
document entitled ``Revised U.S. Public Health Service Recommendations
for Human Immunodeficiency Virus (HIV) Screening of Pregnant Women.''
DATES: Comments must be submitted in writing on or before November 30,
2000. Comments should be submitted to the Technical Information and
Communications Branch, Mailstop E-49, Division of HIV/AIDS Prevention,
National Center for HIV, STD, and TB Prevention, Centers for Disease
Control and Prevention (CDC), 1600 Clifton Road, NE., Atlanta, Georgia
30333; Fax: 404-639-2007; E-mail: hivmail@cdc.gov.
FOR FURTHER INFORMATION CONTACT: Requests for copies of the draft
``Revised U.S. Public Health Service Recommendations for Human
Immunodeficiency Virus (HIV) Screening of Pregnant Women'' should be
submitted to the CDC National Prevention Information Network, P.O. Box
6003, Rockville, Maryland 20849-6003; telephone (800) 458-5231; or
copies can be downloaded from the Division of HIV/AIDS Prevention
website at www.cdc.gov/hiv.
SUPPLEMENTARY INFORMATION: In 1994, the U.S. Public Health Service
(USPHS) published guidelines for use of zidovudine (ZDV) to reduce
perinatal HIV transmission. In 1995, the USPHS issued guidelines
recommending universal counseling and voluntary HIV testing of all
pregnant women and treatment for those found to be infected.
Publication of these recommendations was followed by rapid
implementation by health care providers, widespread acceptance of
chemoprophylaxis by HIV-infected women, and a steep and sustained
decline in perinatal HIV transmission. Observational studies have
confirmed the effectiveness of ZDV in reducing the risk of perinatal
transmission that has resulted in a greater than 75% decline in
pediatric AIDS cases diagnosed in 1998. Despite this progress, children
are still becoming infected, with 300-400 babies being born with HIV
each year in the United States. Studies show that many women,
especially those who use illicit drugs, are not being tested for HIV
during pregnancy because of lack of prenatal care.
In 1998, the Institute of Medicine (IOM) completed a study to
assess the impact of current approaches for reducing perinatal HIV
transmission, identify barriers to further reductions, and determine
ways to overcome these barriers. They concluded that continued
transmission is mainly due to a lack of awareness of HIV status among
some pregnant women and that HIV testing should be simplified and
routinized. IOM recommended that testing should be offered to all
pregnant women as part of the standard battery of prenatal tests,
regardless of risk factors and the HIV prevalence rates in the
community. They also recommended that women should be informed that the
HIV test is being done and of their right to refuse to be tested.
To address these and other issues, the USPHS convened an expert
consultation in April 1999 and sought widespread public comment in
revising the 1995 guidelines for HIV counseling and testing for
pregnant women. The resulting guidelines presented in the draft
``Revised U.S. Public Health Service Recommendations for Human
Immunodeficiency Virus (HIV) Screening of Pregnant Women'' differ
[[Page 65243]]
from the 1995 guidelines in the following ways: (1) Emphasize HIV
testing as a routine part of prenatal care and strengthen the
recommendation that all pregnant women be voluntarily tested for HIV;
(2) recommend a simplification of the testing process so that
previously required pretest counseling is not a barrier to the
provision of testing; (3) make the consent process more flexible to
allow for various types of informed consent; (4) recommend that
providers explore and address reasons for refusal of testing; and (5)
place more emphasis on HIV testing and treatment at the time of
delivery for women who have not received prenatal testing and
chemoprophylaxis.
Dated: October 25, 2000.
Joseph R. Carter,
Associate Director for Management and Operations, Centers for Disease
Control and Prevention.
[FR Doc. 00-27870 Filed 10-30-00; 8:45 am]
BILLING CODE 4163-18-P