Synopsis for November 26, 2004

The MMWR is embargoed until Thursday, 12 PM EDT.

1. Introduction of Routine HIV Testing in Prenatal Care ― Botswana, 2004
2. Two Cases of Hantavirus Pulmonary Syndrome ― Randolph County, West Virginia, July 2004
3. Serious Psychological Distress Among Persons with Diabetes ― New York City, 2003

Synopsis for November 26, 2004

Introduction of Routine HIV Testing in Prenatal Care ― Botswana, 2004

Prenatal clinics in Botswana have offered HIV screening and prevention services since 2001, but low HIV testing rates have hindered the nation’s mother-to-child HIV prevention efforts. Data released today, however, found that when Botswana adopted a national routine testing policy, substantially greater numbers of pregnant women received HIV testing and learned their status.

In 2004, several clinics in Francistown, the nation’s second largest city, switched from an “opt-in” testing policy, where patients receive pre-test counseling and actively choose to be tested for HIV, to a routine testing approach, which combines group education about HIV with an opportunity to decline or “opt-out” of testing. Under the first three months of the new approach, 90.5 % of women were tested, compared to 75.3% during the last four months of the previous policy. Still, many women who were tested never learned their status, due to delays in providing test results and missed follow-up visits. To further increase the percentage of women who learn their HIV status and benefit from prevention services, the government of Botswana plans to train clinic counselors in the use of same-day rapid testing.

Two Cases of Hantavirus Pulmonary Syndrome ― Randolph County, West Virginia, July 2004

Hantavirus pulmonary syndrome (HPS) is a rare but potentially fatal illness caused by viruses of the genus Hantavirus, which are found in the excreta (i.e. urine, saliva, and feces) of a variety of rodent species.

In July 2004, two cases (one fatal) that occurred in West Virginia highlight the presence of these viruses throughout the country, and not just in the Southwest as originally described when U.S. cases were first reported in 1993. A person can become infected by inhaling contaminated dust, or by handling rodents or touching one’s nose or mouth after handling contaminated materials. Rodent control in and around the home, and safe cleanup of rodent excreta, remain the primary strategies for preventing infection. Safe cleanup includes spraying with disinfectant prior to cleaning, using gloves, and washing hands after removing gloves.

Serious Psychological Distress Among Persons with Diabetes ― New York City, 2003

Diabetes care providers should be alert to recognize, treat or make referrals for SPD among their patients. But, while recognition and treatment of SPD is necessary, it may not be sufficient. An integrated program of physical and mental health care that removes socioeconomic barriers and improves access to treatment may be needed to improve the overall health of persons with diabetes and SPD.

Data from New York City indicate that adults with diabetes were twice as likely as other adults to experience serious psychological distress (SPD), and that adults with both SPD and diabetes were more likely to report poor health, live in poverty, lack access to health care, and to have lost a spouse or partner to separation, divorce or death. Persons with comorbid diabetes and SPD face formidable economic and social obstacles to receiving appropriate health care.

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