Working Group Members
- Margaret Lampe: Division of HIV/AIDS Prevention (DHAP); National Center for HIV, STD, and TB Prevention (NCHSTP); Centers for Disease Control and Prevention (CDC);
Atlanta, Georgia
- Bernard Branson: DHAP, NCHSTP, CDC
- Sindy Paul: Division of AIDS Prevention and Control; New Jersey Department of Health and Senior Services; Trenton
- Carolyn Burr: François-Xavier Bagnoud Center; University of Medicine & Dentistry of New Jersey; Newark
- Elaine Gross: François-Xavier Bagnoud Center; University of Medicine & Dentistry of New Jersey; Newark
- Cynthia Eicher: Medical Center of Louisiana Blood Bank; New Orleans
- Robert Maupin: Department of Obstetrics and Gynecology; Louisiana State University School of Medicine; New Orleans
- Dawn Averitt: The Well Project; Asheville, North Carolina
- Brian Forsyth: Department of Pediatrics; Yale University School of Medicine;
New Haven, Connecticut
- Mary Glenn Fowler: DHAP, NCHSTP, CDC
Introduction
Effective interventions are available to reduce the rate of perinatal
HIV transmission when women are identified as HIV infected early in pregnancy.
Pregnant women who are HIV infected but who do not receive prenatal care
or do not receive an HIV test during prenatal care are not identified
as HIV infected and therefore miss opportunities to reduce the risk of
transmission to their infants and to receive life-saving treatments for
themselves. With the implementation of screening programs using rapid
HIV testing in labor and delivery settings, women with unknown HIV test
results during prenatal care (results not documented in the prenatal
medical record) can learn their HIV status quickly and receive short-course
antiretroviral (ARV) prophylaxis to dramatically reduce the risk of transmitting
HIV to their infants. The Centers for Disease Control and Prevention
(CDC) recommends routine rapid HIV testing using an opt-out approach
for women in labor whose HIV status is unknown (see Dear Colleague Letter,
Appendix A).
As a result of a congressional mandate contained in the Ryan White CARE
Act Amendments of 2000 that a study should be conducted of perinatal
HIV transmission in the United States, the Office of the Inspector
General (OIG) issued a 2002 report entitled “Reducing Obstetrician
Barriers to HIV Testing.”1 One of the recommendations
in the report is that “CDC should facilitate the development
and states’ implementation
of protocols for HIV testing during labor and delivery in order to
promote testing in this setting as the standard of care.” Implementing
rapid testing and short-course ARV prophylaxis in labor and delivery
settings is feasible, but as is true when implementing any new screening
program and clinical intervention, there are challenges. CDC has
established a working group of 10 persons with expertise in obstetrics,
pediatrics,
public health practice, nursing, health education and training, blood
screening and laboratory science, epidemiology, and rapid HIV testing
technology to develop this model protocol for rapid HIV screening
for women in labor. The working group represents academic institutions
and university hospitals, a peer advocacy and support organization
for women living with HIV infection, state and federal health agencies,
as well as an internationally recognized HIV training and education
organization. Each member of the group brings diverse experiences
with
rapid HIV testing to this document. The committee recognizes that
as rapid HIV testing is more routinely implemented in labor and delivery
settings, more knowledge will be gained. This guide will therefore
be maintained as a “living document” and will be regularly
updated and maintained on the CDC Web sites; it can be viewed on
the perinatal HIV prevention site
and the rapid HIV testing site.
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