ArticlePloS one2013
Prevention of mother-to-child transmission of HIV: cost-effectiveness of antiretroviral regimens and feeding options in Rwanda.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed, 29 citations in OpenAlex.
- Economic costs and cost-effectiveness of conditional cash transfers for the uptake of services for the prevention of vertical HIV transmissions in a resource-limited setting.Social science & medicine (1982) · 2023Trial
- Understanding rapid implementation from discovery to scale: Rwanda's implementation of rotavirus vaccines and PMTCT in the quest to reduce under-5 mortality.BMC pediatrics · 2024Article
- Projected impact of fast-tracking of anti-retroviral treatment coverage on vertical transmission of HIV in India.PLOS global public health · 2024Article
- HIV testing and knowledge on mother-to-child transmission among pregnant women attending antenatal care at Vanga Hospital, Democratic Republic of Congo.Journal of public health in Africa · 2023Article
- Determinants of comprehensive knowledge on mother-to-child transmission of HIV and its prevention among childbearing women in Rwanda: insights from the 2020 Rwandan Demographic and Health Survey.BMC public health · 2023Article
- Article
- Cost-effectiveness of HIV Prevention Interventions in Sub-Saharan Africa: A Systematic Review.EClinicalMedicine · 2019Article
- The impact of "Option B" on HIV transmission from mother to child in Rwanda: An interrupted time series analysis.PloS one · 2018Article
- Fertility and HIV following universal access to ART in Rwanda: a cross-sectional analysis of Demographic and Health Survey data.Reproductive health · 2017Article
- Decline in Child Hospitalization and Mortality After the Introduction of the 7-Valent Pneumococcal Conjugative Vaccine in Rwanda.The American journal of tropical medicine and hygiene · 2016Article
- The History of the HIV/AIDS Epidemic in Africa.Current HIV/AIDS reports · 2016Review
- 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.Journal of the International AIDS Society · 2016Article
- Economic evaluations of interventions to reduce neonatal morbidity and mortality: a review of the evidence in LMICs and its implications for South Africa.Cost effectiveness and resource allocation : C/E · 2016Article
- Sexual Behavior and Risk Practices of HIV Positive and HIV Negative Rwandan Women.AIDS and behavior · 2015Article
- A narrative review of cost-effectiveness analysis of people living with HIV treated with HAART: from interventions to outcomes.ClinicoEconomics and outcomes research : CEOR · 2015Review
- The incremental cost of switching from Option B to Option B+ for the prevention of mother-to-child transmission of HIV.Bulletin of the World Health Organization · 2014Article
- Implementing primary health care-based PMTCT interventions: operational perspectives from Muhima cohort analysis (Rwanda).The Pan African medical journal · 2014Article
- Health outcomes and cost impact of the new WHO 2013 guidelines on prevention of mother-to-child transmission of HIV in Zambia.PloS one · 2014Article
- What is needed to eliminate new pediatric HIV infections: the contribution of model-based analyses.Current opinion in HIV and AIDS · 2013Review
- Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRwanda's National PMTCT program aims to achieve elimination of new HIV infections in children by 2015. In November 2010, Rwanda adopted the WHO 2010 ARV guidelines for PMTCT recommending Option B (HAART) for all HIV-positive pregnant women extended throughout breastfeeding and discontinued (short course-HAART) only for those not eligible for life treatment. The current study aims to assess the cost-effectiveness of this policy choice.
methodsBased on a cohort of HIV-infected pregnant women in Rwanda, we modelled the cost-effectiveness of six regimens: dual ARV prophylaxis with either 12 months breastfeeding or replacement feeding; short course HAART (Sc-HAART) prophylaxis with either 6 months breastfeeding, 12 months breastfeeding, or 18 months breastfeeding; and Sc-HAART prophylaxis with replacement feeding. Direct costs were modelled based on all inputs in each scenario and related unit costs. Effectiveness was evaluated by measuring HIV-free survival at 18 months. Savings correspond to the lifetime costs of HIV treatment and care avoided as a result of all vertical HIV infections averted.
resultsAll PMTCT scenarios considered are cost saving compared to "no intervention." Sc-HAART with 12 months breastfeeding or 6 months breastfeeding dominate all other scenarios. Sc-HAART with 12 months breastfeeding allows for more children to be alive and HIV-uninfected by 18 months than Sc-HAART with 6 months breastfeeding for an incremental cost per child alive and uninfected of 11,882 USD. This conclusion is sensitive to changes in the relative risk of mortality by 18 months for exposed HIV-uninfected children on replacement feeding from birth and those who were breastfed for only 6 months compared to those breastfeeding for 12 months or more.
conclusionOur findings support the earlier decision by Rwanda to adopt WHO Option B and could inform alternatives for breastfeeding duration. Local contexts and existing care delivery models should be part of national policy decisions.
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