The incremental cost of switching from Option B to Option B+ for the prevention of mother-to-child transmission of HIV

O’Brien, Lisa; Shaffer, Nathan; Sangrujee, Nalinee; Abimbola, Taiwo

doi:10.2471/blt.13.122523

Cited by 26 publications

(14 citation statements)

References 16 publications

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“…These studies provide evidence supporting WHO guidelines of transitioning from Option A and of recommending PMTCT Option B and Option B +. When WHO began the policy transition from Option B to Option B + in 2013, the agency conducted a preliminary cost analysis to estimate the incremental cost of switching to the new policy [75]. The authors argued that researchers should develop additional cost-effectiveness models to appropriately evaluate the cost of the policy with programmatic data.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of HIV Prevention Interventions in Sub-Saharan Africa: A Systematic Review

et al. 2019

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Background Sub-Saharan Africa carries the highest HIV burden globally. It is important to understand how interventions cost-effectively fit within guidelines and implementation plans, especially in low- and middle-income settings. We reviewed the evidence from economic evaluations of HIV prevention interventions in sub-Saharan Africa to help inform the allocation of limited resources. Methods We searched PubMed, Web of Science, Econ-Lit, Embase, and African Index Medicus. We included studies published between January 2009 and December 2018 reporting cost-effectiveness estimates of HIV prevention interventions. We extracted health outcomes and cost-effectiveness ratios (CERs) and evaluated study quality using the CHEERS checklist. Findings 60 studies met the full inclusion criteria. Prevention of mother-to-child transmission interventions had the lowest median CERs ($1144/HIV infection averted and $191/DALY averted), while pre-exposure prophylaxis interventions had the highest ($13,267/HIA and $799/DALY averted). Structural interventions (partner notification, cash transfer programs) have similar CERs ($3576/HIA and $392/DALY averted) to male circumcision ($2965/HIA) and were more favourable to treatment-as-prevention interventions ($7903/HIA and $890/DALY averted). Most interventions showed increased cost-effectiveness when prioritizing specific target groups based on age and risk. Interpretation The presented cost-effectiveness information can aid policy makers and other stakeholders as they develop guidelines and programming for HIV prevention plans in resource-constrained settings.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of HIV Prevention Interventions in Sub-Saharan Africa: A Systematic Review

et al. 2019

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“…Most importantly, Option B+ simplifies PMTCT strategies and avoids the reliance on CD4 count measurements, which is an important barrier to the timely initiation of ART in many rural African settings . Several studies have also shown its cost‐effectiveness . Despite initial optimistic data on retention in Malawi , other reports showed that high losses to follow‐up (LTFU) and poor adherence to ART could be major drawbacks of this strategy .…”

Section: Introductionmentioning

confidence: 99%

Retention in care of HIV‐infected pregnant and lactating women starting ART under Option B+ in rural Mozambique

Llenas-García¹,

Wikman-Jorgensen²,

Hobbins³

et al. 2016

Tropical Med Int Health

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Abstractobjective In 2013, Mozambique adopted Option B+, universal lifelong antiretroviral therapy (ART) for all pregnant and lactating women, as national strategy for prevention of mother-to-child transmission of HIV. We analysed retention in care of pregnant and lactating women starting Option B+ in rural northern Mozambique.methods We compared ART outcomes in pregnant ('B+ pregnant'), lactating ('B+ lactating') and non-pregnant non-lactating women of childbearing age starting ART according to clinical and/or immunological criteria ('own health') between July 2013 and June 2014. Lost to follow-up was defined as no contact >180 days after the last visit. Multivariable competing risk models were adjusted for type of facility (type 1 vs. peripheral type 2 health centre), age, WHO stage and time from HIV diagnosis to ART.results Over 333 person-years of follow-up (243 'B+ pregnant', 65'B+ lactating' and 317 'own health' women), 3.7% of women died and 48.5% were lost to follow-up. 'B+ pregnant' and 'B+ lactating' women were more likely to be lost in the first year (57% vs. 56.9% vs. 31.6%; P < 0.001) and to have no follow-up after the first visit (42.4% vs. 29.2% vs. 16.4%; P < 0.001) than 'own health' women. In adjusted analyses, risk of being lost to follow-up was higher in 'B+ pregnant' (adjusted subhazard ratio [asHR]: 2.77; 95% CI: 2.18-3.50; P < 0.001) and 'B+ lactating' (asHR: 1.94; 95% CI: 1.37-2.74; P < 0.001). Type 2 health centre was the only additional significant risk factor for loss to follow-up.conclusions Retention among PLW starting option B+ ART was poor and mainly driven by early losses. The success of Option B+ for prevention of mother-to-child transmission of HIV in rural settings with weak health systems will depend on specific improvements in counselling and retention measures, especially at the beginning of treatment.

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“…Counseling women on the benefits of uninterrupted cART, irrespective of CD4 count, as recommended by guidelines both nationally and internationally, is very important as adherence to cART and HIV care visits is often more challenging postpartum [14]. Guidelines globally include Option B+ from the WHO, where the goal is to initiate and continue effective antiretroviral therapy for life, in pregnant and breastfeeding women [15,16]. …”

Section: Hiv Infection During Pregnancymentioning

confidence: 99%

HIV and Reproductive Healthcare in Pregnant and Postpartum HIV-infected Women: Adapting Successful Strategies

et al. 2016

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The incremental cost of switching from Option B to Option B+ for the prevention of mother-to-child transmission of HIV

Cited by 26 publications

References 16 publications

Cost-effectiveness of HIV Prevention Interventions in Sub-Saharan Africa: A Systematic Review

Cost-effectiveness of HIV Prevention Interventions in Sub-Saharan Africa: A Systematic Review

Retention in care of HIV‐infected pregnant and lactating women starting ART under Option B+ in rural Mozambique

HIV and Reproductive Healthcare in Pregnant and Postpartum HIV-infected Women: Adapting Successful Strategies

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