[Federal Register Volume 65, Number 211 (Tuesday, October 31, 2000)]
[Notices]
[Pages 65242-65243]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-27870]


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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.

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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: [email protected].

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