Abstract

Rimawi and colleagues are to be commended for drawing our attention to an easily overlooked but common flaw in our healthcare system—the failure to provide efficacious, low-tech services in a timely manner.¹Their study, conducted in eastern North Carolina, found that in almost half of all pregnancies complicated by human immunodeficiency virus (HIV) infection, the infection was initially discovered at a prenatal visit rather than at preconception. Worse, even after the HIV infection was diagnosed, a considerable delay often occurred between diagnosis and the initiation of highly active antiretroviral therapy, and only 45% of the women went into labor with an undetectable viral load. Many unnecessary cesarean sections were performed as a result of this failure to achieve an undetectable viral load before delivery and five children were born infected with HIV.