Cost-Effectiveness of HIV Rescreening During Late Pregnancy to Prevent Mother-to-Child HIV Transmission in South Africa and Other Resource-Limited Settings

Soorapanth, Sada; Sansom, Stephanie L.; Bulterys, Marc; Besser, Mitchell; Theron, Gerhard; Fowler, Mary Glenn

doi:10.1097/01.qai.0000214812.72916.bc

Cited by 32 publications

(55 citation statements)

References 22 publications

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“…South Africa is a country with very high HIV prevalence as well as HIV incidence. The cost-effectiveness of HIV re-screening during pregnancy in South Africa was shown to prevent a substantial number of infant HIV infections and save costs to the healthcare system 19. Our findings will help NACO in shaping the national policy for strengthening the PMTCT programme.…”

Section: Discussionmentioning

confidence: 72%

Cost-effectiveness of a repeat HIV test in pregnancy in India

et al. 2015

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ObjectiveTo evaluate cost-effectiveness of second HIV test in pregnancy.BackgroundCurrent strategy of single HIV test during pregnancy in India can miss new HIV infections acquired after the first test or those HIV infections that were missed in the first test due to a false-negative HIV test.MethodsBetween August 2011 and April 2013, 9097 pregnant HIV uninfected women were offered a second HIV test near term (34 weeks or beyond) or within 4 weeks of postpartum period. A decision analysis model was used to evaluate cost-effectiveness of a second HIV test in pregnant women near term.Primary and secondary outcomeOur key outcome measures include programme cost with addition of second HIV test in pregnant women and quality-adjusted life years (QALYs) gained.ResultsWe detected 4 new HIV infections in the second test. Thus HIV incidence among pregnant women was 0.12 (95% 0.032 to 0.297) per 100 person women years (PWY). Current strategy of a single HIV test is 8.2 times costlier for less QALYs gained as compared to proposed repeat HIV testing of pregnant women who test negative during the first test.ConclusionsOur results warrant consideration at the national level for including a second HIV test of all pregnant women in the national programme. However prior to allocation of resources for a second HIV test in pregnancy, appropriate strategies will have to be planned for improving compliance for prevention of mother-to-child transmission of HIV and reducing loss-to-follow-up of those women detected with HIV.Trial registration numberCTRI/2013/12/004183.

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Section: Discussionmentioning

confidence: 72%

Cost-effectiveness of a repeat HIV test in pregnancy in India

et al. 2015

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“…Provision of the female condom to sex workers was found to be cost saving if adjusted for averted medical care costs [28]. A study of rescreening for HIV during late pregnancy found net savings [29], and another study found that targeted STI treatment in sex workers costs $78 per disability-adjusted life year (DALY) [30]. Other studies did not use the outcome metric of costs per HIA or per life year saved [21,29–32].…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Male Circumcision for HIV Prevention in a South African Setting

2006

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BackgroundConsistent with observational studies, a randomized controlled intervention trial of adult male circumcision (MC) conducted in the general population in Orange Farm (OF) (Gauteng Province, South Africa) demonstrated a protective effect against HIV acquisition of 60%. The objective of this study is to present the first cost-effectiveness analysis of the use of MC as an intervention to reduce the spread of HIV in sub-Saharan Africa.Methods and FindingsCost-effectiveness was modeled for 1,000 MCs done within a general adult male population. Intervention costs included performing MC and treatment of adverse events. HIV prevalence was estimated from published estimates and incidence among susceptible subjects calculated assuming a steady-state epidemic. Effectiveness was defined as the number of HIV infections averted (HIA), which was estimated by dynamically projecting over 20 years the reduction in HIV incidence observed in the OF trial, including secondary transmission to women. Net savings were calculated with adjustment for the averted lifetime duration cost of HIV treatment. Sensitivity analyses examined the effects of input uncertainty and program coverage. All results were discounted to the present at 3% per year.For Gauteng Province, assuming full coverage of the MC intervention, with a 2005 adult male prevalence of 25.6%, 1,000 circumcisions would avert an estimated 308 (80% CI 189–428) infections over 20 years. The cost is $181 (80% CI $117–$306) per HIA, and net savings are $2.4 million (80% CI $1.3 million to $3.6 million). Cost-effectiveness is sensitive to the costs of MC and of averted HIV treatment, the protective effect of MC, and HIV prevalence. With an HIV prevalence of 8.4%, the cost per HIA is $551 (80% CI $344–$1,071) and net savings are $753,000 (80% CI $0.3 million to $1.2 million). Cost-effectiveness improves by less than 10% when MC intervention coverage is 50% of full coverage.ConclusionsIn settings in sub-Saharan Africa with high or moderate HIV prevalence among the general population, adult MC is likely to be a cost-effective HIV prevention strategy, even when it has a low coverage. MC generates large net savings after adjustment for averted HIV medical costs.

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“…Health service costs for each PMTCT follow-up visit were based on WHO Choosing Interventions that are Cost Effective [35]. We assumed that 20 quality-adjusted life years ( QALYs) would be gained by averting a new paediatric HIV infection [36,37]. The main model inputs are summarized in Table 1.…”

Section: Methodsmentioning

confidence: 99%

Should HIV testing for all pregnant women continue? Cost‐effectiveness of universal antenatal testing compared to focused approaches across high to very low HIV prevalence settings

Ishikawa

Dalal

Johnson

et al. 2016

Journal of the International AIDS Society

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IntroductionHIV testing is the entry point for the elimination of mother-to-child transmission of HIV. Decreasing external funding for the HIV response in some low- and middle-income countries has triggered the question of whether a focused approach to HIV testing targeting pregnant women in high-burden areas should be considered. This study aimed at determining and comparing the cost-effectiveness of universal and focused HIV testing approaches for pregnant women across high to very low HIV prevalence settings.MethodsWe conducted a modelling analysis on health and cost outcomes of HIV testing for pregnant women using four country-based case scenarios (Namibia, Kenya, Haiti and Viet Nam) to illustrate high, intermediate, low and very low HIV prevalence settings. We used subnational prevalence data to divide each country into high-, medium- and low-burden areas, and modelled different antenatal and testing coverage in each.ResultsWhen HIV testing services were only focused in high-burden areas within a country, mother-to-child transmission rates remained high ranging from 18 to 23%, resulting in a 25 to 69% increase in new paediatric HIV infections and increased future treatment costs for children. Universal HIV testing was found to be dominant (i.e. more QALYs gained with less cost) compared to focused approaches in the Namibia, Kenya and Haiti scenarios. The universal approach was also very cost-effective compared to focused approaches, with $ 125 per quality-adjusted life years gained in the Viet Nam-based scenario of very low HIV prevalence. Sensitivity analysis further supported the findings.ConclusionsUniversal approach to antenatal HIV testing achieves the best health outcomes and is cost-saving or cost-effective in the long term across the range of HIV prevalence settings. It is further a prerequisite for quality maternal and child healthcare and for the elimination of mother-to-child transmission of HIV.

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Cost-Effectiveness of HIV Rescreening During Late Pregnancy to Prevent Mother-to-Child HIV Transmission in South Africa and Other Resource-Limited Settings

Cited by 32 publications

References 22 publications

Cost-effectiveness of a repeat HIV test in pregnancy in India

Cost-effectiveness of a repeat HIV test in pregnancy in India

Cost-Effectiveness of Male Circumcision for HIV Prevention in a South African Setting

Should HIV testing for all pregnant women continue? Cost‐effectiveness of universal antenatal testing compared to focused approaches across high to very low HIV prevalence settings

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