Computer simulation models can identify key clinical, operational, and economic interventions that will be needed to achieve the elimination of new pediatric HIV infections. In this review, we summarize recent findings from model-based analyses of strategies for prevention of mother-to-child HIV transmission (MTCT).
In order to achieve elimination of MTCT (eMTCT), model-based studies suggest that scale-up of services will be needed in several domains: uptake of services and retention in care (the PMTCT ‘cascade’), interventions to prevent HIV infections in women and reduce unintended pregnancies (the ‘four-pronged approach’), efforts to support medication adherence through long periods of pregnancy and breastfeeding, and strategies to make breastfeeding safer and/or shorter. Models also project the economic resources that will be needed to achieve these goals in the most efficient ways to allocate limited resources for eMTCT. Results suggest that currently recommended PMTCT regimens (WHO Option A, Option B, and Option B+) will be cost-effective in most settings.
Model-based results can guide future implementation science, by highlighting areas in which additional data are needed to make informed decisions and by outlining critical interventions that will be necessary in order to eliminate new pediatric HIV infections.
aThe Medical Practice Evaluation Center, Divisions of General Medicine
bInfectious Disease, Massachusetts General Hospital, Boston, Massachusetts, USA
Correspondence to Katie Doherty, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, Massachusetts 02114, USA. Tel: +1 617 724 8847; fax: +1 617 726 2691; e-mail: firstname.lastname@example.org