To estimate the cost-effectiveness of HIV screening strategies for the prevention of perinatal transmission in Uganda, a resource-limited country with high HIV prevalence and incidence.
We designed a decision analytic model from a health care system perspective to assess the vertical transmission rates and cost-effectiveness of 4 different HIV screening strategies in pregnancy: (1) rapid HIV antibody (Ab) test at initial visit (current standard of care), (2) strategy 1 + HIV RNA at initial visit (adds detection of acute HIV), (3) strategy 1 + repeat HIV Ab at delivery (adds detection of incident HIV), and (4) strategy 3 + HIV RNA at delivery (adds detection of acute HIV at delivery). Model estimates were derived from the literature and local sources, and life years saved were discounted at a rate of 3% per year. Based on World Health Organization guidelines, we defined our cost-effectiveness threshold as ≤3 times the gross domestic product per capita, which for Uganda was US$3300 in 2008.
Using base case estimates of 10% HIV prevalence among women entering prenatal care and 3% incidence during pregnancy, strategy 3 was incrementally the cost-effective option that led to the greatest total life years.
Repeat rapid HIV Ab testing at the time of labor is a cost-effective strategy even in a resource-limited setting such as Uganda.
*Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA;
†Department of Obstetrics, Gynecology & Reproductive Biology, Brigham and Women’s Hospital, Boston, MA;
‡Infectious Disease Research Collaboration, Kampala, Uganda; and
§Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR.
Correspondence to: Lena H. Kim, MD, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 505 Parnassus, Box 0132, San Francisco, CA 94143-0132 (e-mail: firstname.lastname@example.org).
L. H. K was supported by the National Institutes of Health 5T12 HD007162-29 (Graduate Research Training in Perinatal Biology Award).
Presented at the Society for Maternal-Fetal Medicine 2010 30th Annual Meeting, February 1–6, 2010, Chicago, IL.
The authors have no conflicts of interest to disclose.
Received October 15, 2012
Accepted January 22, 2013