Cost-effective use of nevirapine to prevent vertical HIV transmission in sub-Saharan Africa
Cost-effective use of nevirapine to prevent vertical HIV transmission in sub-Saharan Africa
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DOI：
10.1097/00126334-200008010-00012
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发表时间：
2000-08-01
期刊：
影响因子：
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通讯作者：
Stinnett, AA
中科院分区：
文献类型：
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作者：
Stringer, JSA;Rouse, DJ;Stinnett, AA
目的：评估在撒哈拉以南非洲地区使用奈韦拉平(NVP)预防HIV垂直传播的替代策略的成本-效果。设计：构建决策分析模型，评估基于NVP的预防策略在两组不同的妇女中的成本和效果：通过参加36周的产前访问获得标准治疗的妇女，以及因早产或缺乏产前护理而不符合条件的妇女。结果：对于产前护理的妇女，与仅向那些被确认为阳性的妇女提供靶向治疗相比，发现在产前护理中，大规模提供没有孕妇血清诊断的NVP可以以可接受的成本获得更大的健康收益。然而，这一结论很大程度上取决于几个不确定的假设，最重要的是，不知道自己血清状态的女性仍然会坚持治疗的可能性。在那些没有事先登记参加产前战略的孕妇中，晚提供母婴NVP或只治疗婴儿可能是目前不提供预防性治疗的一种经济有效的替代方法。结论：NVP干预为预防撒哈拉以南非洲地区的HIV垂直传播提供了一种经济有效的途径。如果没有关于不知道其血清状况的妇女坚持治疗的信息，就不能自信地确定大众治疗和靶向治疗之间的最佳选择。对于没有在产前接受NVP治疗的妇女来说，即使临床疗效不高，在临产时进行治疗也是划算的。迫切需要对不知道自身状况和非传染性非传染性胃炎替代治疗方法现场有效性的妇女坚持治疗的情况进行临床评估，以便确定最佳预防战略。
Objective: To assess the cost-effectiveness of alternative strategies of nevirapine (NVP) administration to prevent vertical HIV transmission in sub-Saharan Africa.Design: A decision-analysis model was constructed to estimate the costs and effects of NVP-based prevention strategies for two separate groups of women: those who qualify for standard therapy by attending a 36-week prenatal visit, and those who do not qualify, owing to preterm delivery or lack of prenatal care.Results: For women in prenatal care, mass provision of NVP without maternal serodiagnosis was found to yield greater health gains at an acceptable cost, compared with providing targeted therapy to only those women identified as seropositive. However, this conclusion was strongly contingent on several uncertain assumptions, most importantly the probability that a woman who does not know her serostatus will nonetheless adhere to therapy. Among those women who present for delivery without prior enrollment in a prenatal strategy, either late provision of maternal-infant NVP or treatment of only the infant would likely be a cost-effective alternative to the current practice of offering no preventive therapy.Conclusions: NVP intervention offers a cost-effective avenue for preventing vertical HIV transmission in sub-Saharan Africa. The optimal choice between mass therapy and targeted therapy cannot be confidently identified without information regarding adherence among women who do not know their serostatus. For women who do not receive NVP prenatally, treatment on presentation for delivery would be cost-effective even in the face of modest clinical efficacy. Clinical assessment of adherence to therapy among women who do not know their status and the field effectiveness of alternative approaches to NVP administration is urgently needed to allow identification of optimal prevention strategies.