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
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
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DOI：
10.7448/ias.19.1.21212
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发表时间：
2016-12-14
影响因子：
6
通讯作者：
Baggaley, Rachel
中科院分区：
文献类型：
--
作者：
Ishikawa, Naoko;Dalal, Shona;Baggaley, Rachel
简介：艾滋病检测是消除艾滋病母婴传播的切入点。一些低收入和中等收入国家用于艾滋病毒应对工作的外部资金减少引发了一个问题：是否应考虑针对高负担地区的孕妇采取有针对性的艾滋病毒检测方法。本研究旨在确定和比较针对高至极低艾滋病毒流行地区孕妇的普遍和有针对性的艾滋病毒检测方法的成本效益。方法：我们使用四个国家的案例情景（纳米比亚、肯尼亚、海地和越南）对孕妇艾滋病毒检测的健康和成本结果进行了建模分析，以说明高、中、低和极低艾滋病毒流行地区。我们利用地方流行率数据将每个国家分为高、中、低负担地区，并对每个国家不同的产前和检测覆盖率进行建模。结果：当艾滋病毒检测服务仅集中于一个国家内的高负担地区时，母婴传播率仍然很高，在 18% 至 23% 之间，导致新发儿科艾滋病毒感染增加 25% 至 69%，并增加儿童未来的治疗费用。与纳米比亚、肯尼亚和海地情景中的集中方法相比，普遍的艾滋病毒检测被发现占主导地位（即以更少的成本获得更多的质量调整生命年）。与集中方法相比，通用方法也非常具有成本效益，在越南艾滋病毒感染率极低的情况下，每个质量调整生命年可节省 125 美元。敏感性分析进一步支持了这一发现。结论：产前艾滋病毒检测的通用方法可以实现最佳的健康结果，并且从长远来看，在艾滋病毒流行地区范围内可以节省成本或具有成本效益。这也是优质妇幼保健和消除艾滋病毒母婴传播的先决条件。
Introduction: HIV 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.Methods: We 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.Results: When 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.Conclusions: Universal 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.