The Cost-Effectiveness of Repeat HIV Testing During Pregnancy in a Resource-Limited Setting

Kim, Lena H.; Cohan, Deborah; Sparks, Teresa N.; Pilliod, Rachel A.; Arinaitwe, Emmanuel; Caughey, Aaron B.

doi:10.1097/qai.0b013e3182895565

Cited by 17 publications

(35 citation statements)

References 25 publications

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“…Repeat maternal testing is feasible, cost-effective and acceptable to women both at the time of delivery and at immunisation clinics. 44,45 In South Africa most women deliver in healthcare facilities and 95% attend the 6-week immunisation visit. 6,7,37–39,46,47 Repeat testing at these times has since been incorporated into updated PMTCT guidelines (April 2013).…”

Section: Discussionmentioning

confidence: 99%

Timing of Maternal HIV Testing and Uptake of Prevention of Mother-to-Child Transmission Interventions Among Women and Their Infected Infants in Johannesburg, South Africa

Technau

Kalk

Coovadia

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background By 2011, South African prevention of mother-to-child transmission of HIV (PMTCT) programmes had reduced perinatal HIV transmission at 6-weeks of age to 2.7%. We investigated the profile of newly-diagnosed vertically-infected children and their mothers to identify short-falls in the PMTCT programme. Methods In this operational follow-up study, fieldworkers enrolled mothers of newly-diagnosed HIV-infected children up to 2 years of age at 5 major healthcare facilities in Johannesburg. Structured questionnaires and clinical record reviews were conducted and analysed to describe the population and assess factors associated with PMTCT uptake. Results 289 mother-child pairs were enrolled. Timing of maternal HIV diagnosis influenced PMTCT access and feeding choices, and was associated with infants’ age at HIV diagnosis (7 weeks vs. 11 weeks vs. 31 weeks where mothers tested before, during or after the pregnancy respectively; p <0.0001). Women diagnosed before pregnancy (12%) were older (median 31 years) than those diagnosed during the index pregnancy (53% - median 27 years). Women diagnosed after delivery (35%) were younger (median 25 years, p<0.0001), of lower parity, and less likely to be South African citizens. In 81 cases (29%) late maternal diagnosis precluded any PMTCT access. Where women were diagnosed during or before pregnancy, the recommended PMTCT guidelines for mother and infant were followed in 86 (61%) pairs. Conclusion Failure to diagnose maternal HIV infection before delivery was the main reason for missing PMTCT prophylaxis and early infant testing. Timely maternal diagnosis enables PMTCT uptake, but implementation and follow-up gaps require attention to improve infant outcomes.

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Section: Discussionmentioning

confidence: 99%

Timing of Maternal HIV Testing and Uptake of Prevention of Mother-to-Child Transmission Interventions Among Women and Their Infected Infants in Johannesburg, South Africa

Technau

Kalk

Coovadia

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…While the risk of HIV transmission through breastfeeding continues for up to two years, few exposed infants are re-tested after testing at 4–6 weeks of life [13, 14], which only identifies those children infected in the uterus or during delivery [15]. Consequently, many HIV-exposed children remain with unknown HIV status.…”

Section: Introductionmentioning

confidence: 99%

Rate and associated factors of non-retention of mother-baby pairs in HIV care in the elimination of mother-to-child transmission programme, Gulu-Uganda: a cohort study

Obai

Mubeezi

Makumbi

2017

BMC Health Serv Res

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BackgroundPoor retention in HIV care of mother-baby pairs remains a public health challenge in the elimination of mother-to-child transmission (eMTCT) of HIV. We determined the rate of non-retention and time to non-retention of mother-baby pairs and associated factors in Gulu district, Northern Uganda.MethodsMother-baby pairs enrolled into the eMTCT programme at Gulu Regional Referral Hospital (GRRH) and Lacor Hospital (LH) were retrospectively followed for 18 months. The primary outcomes were the rate of non-retention and time to non-retention of mother-baby pairs in HIV care. Data were abstracted from the antiretroviral treatment and early infant diagnosis (EID) registers, and mother/baby appointment books at the health facilities. Additional data on possible reasons for non-retention were obtained from cross-sectional interviews of mothers. Time to non-retention was calculated as the duration between enrolment of mother-baby pair into care and the date when the mother and/or baby missed a scheduled visit and did not return within 30 days. Factors associated with time to non-retention were assessed using Cox proportional hazards regression analysis. The measures of association were expressed as hazards ratio (HR) with 95% confidence intervals. Alpha was set at 0.05. The adjusted analysis includes variables with p <0.2 in the bivariable analysis or considered potential confounders. The Analysis used Stata version 12.ResultsA total of 410 mother-baby pairs were enrolled in this study. Overall, non-retention by 18 month was 30.5%; higher at GRRH (34.7%) than LH (25.8%), p = 0.049. Non-retention was higher among pairs where the infant had no EID, adjusted (adj) HR = 5.81; 95% CI (2.55, 13.24), non-disclosure of mother’s HIV status, adj.HR = 1.86; 95% CI (1.22, 2.85), and lack of privacy during counselling session, adj.HR = 1.86; 95% CI (1.26, 2.85). Non-retention was about 60% lower [adj.HR = 0.43; 95% CI (0.20, 0.92)] among pairs where the mothers understood and appreciated the importance of adhering to all clinic appointments together with the baby.ConclusionNearly a third of mother-baby pairs are not retained in HIV care. Lack of EID services, poor quality service, non-disclosure of mother’s HIV status, and understanding the importance of adhering to all appointments together with the baby, were associated with time to non-retention.

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“…Some of these studies considered the implementation of similar screenings during pregnancy in countries with different HIV prevalence . In view of Center of Disease Control recommendations, some other studies focused instead on the cost‐effectiveness of HIV rescreening in late pregnancy or in newborns, alone or in combination …”

Section: Introductionmentioning

confidence: 99%

HIV screening in pregnant women: A systematic review of cost‐effectiveness studies

Bert

Gualano

Biancone

et al. 2017

Health Planning & Management

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The review confirmed the cost-effectiveness not only of HIV universal antenatal screening but also of rescreening in late gestation in both developed and developing countries. Universal screening is cost-effective even in case of extremely low HIV prevalence. Therefore, to maximize screening, coverage appears as a worldwide priority. In certain settings, a targeted screening towards high-risk groups could be a valuable option.

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The Cost-Effectiveness of Repeat HIV Testing During Pregnancy in a Resource-Limited Setting

Cited by 17 publications

References 25 publications

Timing of Maternal HIV Testing and Uptake of Prevention of Mother-to-Child Transmission Interventions Among Women and Their Infected Infants in Johannesburg, South Africa

Timing of Maternal HIV Testing and Uptake of Prevention of Mother-to-Child Transmission Interventions Among Women and Their Infected Infants in Johannesburg, South Africa

Rate and associated factors of non-retention of mother-baby pairs in HIV care in the elimination of mother-to-child transmission programme, Gulu-Uganda: a cohort study

HIV screening in pregnant women: A systematic review of cost‐effectiveness studies

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