Costs and benefits of multidrug, multidose antiretroviral therapy for prevention of mother‐to‐child transmission of HIV in the Dominican Republic

Schmidt, Nicole; Roman-Pouriet, José; Fernández, Ariel; Beck-Sagué, Consuelo M.; Leonardo-Guerrero, José; Nicholas, Stephen W.

doi:10.1016/j.ijgo.2011.10.028

Cited by 3 publications

(9 citation statements)

References 18 publications

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“…Since 1994, at least 26 studies have examined the cost-effectiveness of PMTCT programs [25,44,46,53-59]. The earliest studies found that single-dose nevirapine (sdNVP) and antenatal zidovudine monotherapy were either cost-saving or very cost-effective, compared to no intervention, in a range of resource-limited settings [53].…”

Section: Economic Investments Necessary To Eliminate New Pediatric Himentioning

confidence: 99%

“…The earliest studies found that single-dose nevirapine (sdNVP) and antenatal zidovudine monotherapy were either cost-saving or very cost-effective, compared to no intervention, in a range of resource-limited settings [53]. Recently, 9 studies have evaluated Options A, B, or B+, with wide variations in the costs and outcomes considered, as well as the choice of comparator strategies (Table 1) [25,44,46,54-59]. …”

Section: Economic Investments Necessary To Eliminate New Pediatric Himentioning

confidence: 99%

“…The greatest number of recent reports have examined Option B, and found it to be either cost-saving or very cost-effective when compared to no PMTCT, sdNVP, or dual antenatal ARV prophylaxis [25,44,46,54,55,57-59]. Two studies have directly compared Option A to Option B, with conflicting findings.…”

Section: Economic Investments Necessary To Eliminate New Pediatric Himentioning

confidence: 99%

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What is needed to eliminate new pediatric HIV infections

Doherty¹,

Ciaranello²

2013

Current Opinion in HIV and AIDS

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Purpose of Review Computer simulation models can identify key clinical, operational, and economic interventions that will be needed to achieve the elimination of new pediatric HIV infections. In this review, we summarize recent findings from model-based analyses of strategies for prevention of mother-to-child HIV transmission (MTCT). Recent Findings In order to achieve elimination of MTCT (eMTCT), model-based studies suggest that scale-up of services will be needed in several domains: uptake of services and retention in care (the PMTCT “cascade”), interventions to prevent HIV infections in women and reduce unintended pregnancies (the “four-pronged approach”), efforts to support medication adherence through long periods of pregnancy and breastfeeding, and strategies to make breastfeeding safer and/or shorter. Models also project the economic resources that will be needed to achieve these goals in the most efficient ways to allocate limited resources for eMTCT. Results suggest that currently recommended PMTCT regimens (WHO Option A, Option B, and Option B+) will be cost-effective in most settings. Summary Model-based results can guide future implementation science, by highlighting areas in which additional data are needed to make informed decisions and by outlining critical interventions that will be necessary in order to eliminate new pediatric HIV infections.

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Section: Economic Investments Necessary To Eliminate New Pediatric Himentioning

confidence: 99%

Section: Economic Investments Necessary To Eliminate New Pediatric Himentioning

confidence: 99%

Section: Economic Investments Necessary To Eliminate New Pediatric Himentioning

confidence: 99%

See 1 more Smart Citation

What is needed to eliminate new pediatric HIV infections

Doherty¹,

Ciaranello²

2013

Current Opinion in HIV and AIDS

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“…From 1999–2004, in La Romana province, in the region that formerly had the highest HIV prevalence in 2002 [12], nongovernmental organizations provided prenatal, perinatal and neonatal multidose zidovudine-containing regimens, with elective cesarean delivery and exclusive formula feeding, to HIV-infected mothers and their infants [6, 13]. During this time period, all data for this paper were collected from La Romana (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…Virtual elimination of HIV MTCT has been achieved in most industrialized countries, with declines of over 80%–90% in the number of cases of perinatally acquired HIV infection, and MTCT rates of under 2%-3% [3–5]. The use of highly active antiretroviral therapy ([HAART], defined as a regimen of three or more antiretrovirals from two or more classes), which is essential for elimination of MTCT and contributes to maternal health, has been shown to be cost effective compared to single-dose nevirapine in several LMI countries, including the Dominican Republic (DR) [6–8], but few data exist on the scalability of these measures or the current obstacles to eliminating MTCT in these countries [9–13]. …”

Section: Introductionmentioning

confidence: 99%

Progress towards Elimination of HIV Mother-to-Child Transmission in the Dominican Republic from 1999 to 2011

Lorenzo¹,

Beck-Sagué

Bautista-Soriano³

et al. 2012

Infectious Diseases in Obstetrics and Gynecology

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In 1999, prevention of mother-to-child transmission (pMTCT) using antiretrovirals was introduced in the Dominican Republic (DR). Highly active antiretroviral therapy (HAART) was introduced for immunosuppressed persons in 2004 and for pMTCT in 2008. To assess progress towards MTCT elimination, data from requisitions for HIV nucleic acid amplification tests for diagnosis of HIV infection in perinatally exposed infants born in the DR from 1999 to 2011 were analyzed. The MTCT rate was 142/1,274 (11.1%) in 1999–2008 and 12/302 (4.0%) in 2009–2011 (P < .001), with a rate of 154/1,576 (9.8%) for both periods combined. This decline was associated with significant increases in the proportions of women who received prenatal HAART (from 12.3% to 67.9%) and infants who received exclusive formula feeding (from 76.3% to 86.1%) and declines in proportions of women who received no prenatal antiretrovirals (from 31.9% to 12.2%) or received only single-dose nevirapine (from 39.5% to 19.5%). In 2007, over 95% of DR pregnant women received prenatal care, HIV testing, and professionally attended delivery. However, only 58% of women in underserved sugarcane plantation communities (2007) and 76% in HIV sentinel surveillance hospitals (2003–2005) received their HIV test results. HIV-MTCT elimination is feasible but persistent lack of access to critical pMTCT measures must be addressed.

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Uso de terapia antirretroviral de gran actividad (TARGA) y transmisión vertical del VIH. Cuba 1989-2008

Álvarez¹,

Núñez

Corcho

2013

Rev. Bras. Saude Mater. Infant.

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OBJETIVOS: describir el uso de terapia antirretroviral de gran actividad (TARGA) en gestantes cubanas infectadas por el VIH y el comportamiento de la transmisión vertical del VIH, según tratamiento antirretroviral materno usado durante la gestación. MÉTODOS: se realizó un estudio de corte transversal donde se incluyeron 319 niños hijos de mujeres seropositivas al VIH, identificándose en ellos la presencia de infección o no por el VIH; para el análisis se utilizaron medidas descriptivas, la prueba de comparación de tasas y la razón de prevalencia. RESULTADOS: la transmisión vertical del VIH de forma general fue de 5% y esta fue mayor en los años en que no se usaba TARGA (9,5% vs 3,1%; p=0,049). Inicialmente solo recibían TARGA gestantes clasificadas como sida. En el transcurso del tiempo se observó un incremento del uso de este esquema de tratamiento en gestantes y una disminución en la infección de la descendencia (26,3% en 2003 vs 86,7% en 2008 y 10,5% en 2003 vs 2,1% en 2008; respectivamente). La prevalencia de la enfermedad disminuyó al usar un esquema de tratamiento materno de mayor actividad (tendencia lineal p=0,017). CONCLUSIONES: el perfeccionamiento del programa de prevención cubano ha disminuido la transmisión vertical del VIH.

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Costs and benefits of multidrug, multidose antiretroviral therapy for prevention of mother‐to‐child transmission of HIV in the Dominican Republic

Abstract: Despite the high costs, use of MD-ARVs, such as HAART, for PMTCT offer societal savings because fewer perinatally acquired infections are anticipated to require treatment.

Cited by 3 publications

References 18 publications

What is needed to eliminate new pediatric HIV infections

What is needed to eliminate new pediatric HIV infections

Progress towards Elimination of HIV Mother-to-Child Transmission in the Dominican Republic from 1999 to 2011

Uso de terapia antirretroviral de gran actividad (TARGA) y transmisión vertical del VIH. Cuba 1989-2008

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