Document Detail


The cost-effectiveness of repeat HIV testing during pregnancy in a resource-limited setting.
MedLine Citation:
PMID:  23392461     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To estimate the cost-effectiveness of HIV screening strategies for the prevention of perinatal transmission in Uganda, a resource-limited country with high HIV prevalence and incidence.
STUDY DESIGN: We designed a decision analytic model from a health care system perspective to assess the vertical transmission rates and cost-effectiveness of 4 different HIV screening strategies in pregnancy: (1) rapid HIV antibody (Ab) test at initial visit (current standard of care), (2) strategy 1 + HIV RNA at initial visit (adds detection of acute HIV), (3) strategy 1 + repeat HIV Ab at delivery (adds detection of incident HIV), and (4) strategy 3 + HIV RNA at delivery (adds detection of acute HIV at delivery). Model estimates were derived from the literature and local sources, and life years saved were discounted at a rate of 3% per year. Based on World Health Organization guidelines, we defined our cost-effectiveness threshold as ≤3 times the gross domestic product per capita, which for Uganda was US$3300 in 2008.
RESULTS: Using base case estimates of 10% HIV prevalence among women entering prenatal care and 3% incidence during pregnancy, strategy 3 was incrementally the cost-effective option that led to the greatest total life years.
CONCLUSIONS: Repeat rapid HIV Ab testing at the time of labor is a cost-effective strategy even in a resource-limited setting such as Uganda.
Authors:
Lena H Kim; Deborah L Cohan; Teresa N Sparks; Rachel A Pilliod; Emmanuel Arinaitwe; Aaron B Caughey
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  63     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-05-13     Completed Date:  2013-07-08     Revised Date:  2014-06-03    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  195-200     Citation Subset:  IM; X    
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MeSH Terms
Descriptor/Qualifier:
Antiretroviral Therapy, Highly Active
Cost-Benefit Analysis
Decision Support Techniques
Female
HIV Antibodies / blood,  economics
HIV Infections / diagnosis*,  economics,  prevention & control,  transmission*
HIV-1 / genetics,  immunology
Health Resources / economics
Humans
Infectious Disease Transmission, Vertical / prevention & control*
Mass Screening / economics*
Pregnancy
Pregnancy Complications, Infectious / diagnosis,  economics
Prenatal Care / economics*
Quality-Adjusted Life Years
RNA, Viral / analysis
Uganda
Grant Support
ID/Acronym/Agency:
5T12 HD007162-29/HD/NICHD NIH HHS; T32 HD007162/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/HIV Antibodies; 0/RNA, Viral
Comments/Corrections

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