ArticleJournal of the International AIDS Society2016
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.
Article in Journal of the International AIDS Society, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The costs of scaling up HIV and syphilis testing in low- and middle-income countries: a systematic review.Health policy and planning · 2021Pooled it
- 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
- The urgency of now to end HIV vertical transmission for pregnant and breastfeeding women and their children in Asia and the Pacific.The Lancet regional health. Western Pacific · 2024Review
- Growth Trajectories Over the First Year of Life Among Early-Treated Infants with Human Immunodeficiency Virus and Infants Who are Human Immunodeficiency Virus-Exposed Uninfected.The Journal of pediatrics · 2024Article
- The End Is in Sight: Current Strategies for the Elimination of HIV Vertical Transmission.Current HIV/AIDS reports · 2023Review
- Article
- Cost-effectiveness analysis of the prevention of mother-to-child transmission of HIV.Infectious diseases of poverty · 2022Article
- New diagnosis of mother-to-child transmission of HIV in 8 Latin-American countries during 2018.BMC infectious diseases · 2022Article
- Optimizing HIV retesting during pregnancy and postpartum in four countries: a cost-effectiveness analysis.Journal of the International AIDS Society · 2021Article
- Cost-effectiveness of dual maternal HIV and syphilis testing strategies in high and low HIV prevalence countries: a modelling study.The Lancet. Global health · 2021Article
- HIV-1 infection among women in Israel, 2010-2018.BMC infectious diseases · 2020Article
- Antenatal testing for anaemia, HIV and syphilis in Indonesia - a health systems analysis of low coverage.BMC pregnancy and childbirth · 2020Article
- Retest and treat: a review of national HIV retesting guidelines to inform elimination of mother-to-child HIV transmission (EMTCT) efforts.Journal of the International AIDS Society · 2019Article
- HIV testing during pregnancy for prevention of mother-to-child transmission of HIV in Ethiopia.PloS one · 2018Article
- Monitoring Prevention Impact of Mother-to-Child Transmission of HIV in Concentrated Epidemics With Program and Survey Data.JMIR public health and surveillance · 2017Article
- HIV point of care diagnosis: preventing misdiagnosis experience from a pilot of rapid test algorithm implementation in selected communes in Vietnam.Journal of the International AIDS Society · 2017Article
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Authors and funding
10 authors.
Funding
Abstract
introductionHIV testing is the entry point for the elimination of mother-to-child transmission of HIV. Decreasing external funding for the HIV response in some low- and middle-income countries has triggered the question of whether a focused approach to HIV testing targeting pregnant women in high-burden areas should be considered. This study aimed at determining and comparing the cost-effectiveness of universal and focused HIV testing approaches for pregnant women across high to very low HIV prevalence settings.
methodsWe conducted a modelling analysis on health and cost outcomes of HIV testing for pregnant women using four country-based case scenarios (Namibia, Kenya, Haiti and Viet Nam) to illustrate high, intermediate, low and very low HIV prevalence settings. We used subnational prevalence data to divide each country into high-, medium- and low-burden areas, and modelled different antenatal and testing coverage in each.
resultsWhen HIV testing services were only focused in high-burden areas within a country, mother-to-child transmission rates remained high ranging from 18 to 23%, resulting in a 25 to 69% increase in new paediatric HIV infections and increased future treatment costs for children. Universal HIV testing was found to be dominant (i.e. more QALYs gained with less cost) compared to focused approaches in the Namibia, Kenya and Haiti scenarios. The universal approach was also very cost-effective compared to focused approaches, with $ 125 per quality-adjusted life years gained in the Viet Nam-based scenario of very low HIV prevalence. Sensitivity analysis further supported the findings.
conclusionsUniversal approach to antenatal HIV testing achieves the best health outcomes and is cost-saving or cost-effective in the long term across the range of HIV prevalence settings. It is further a prerequisite for quality maternal and child healthcare and for the elimination of mother-to-child transmission of HIV.
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