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Table 1 Overview of economic evaluations of interventions to reduce mother to child transmission (MTCT) of HIV

From: The cost-effectiveness of preventing mother-to-child transmission of HIV in low- and middle-income countries: systematic review

Study

Location (Income) 1

Adult HIV Prevalence 2

Study Population 3

Interventions 4

Study design 5

[32]

SSA6

1% - 26%

100 000 pregnant women

(0) No intervention

(1) CDC Thai

CEA

[33]

SSA

1% - 26%

100 pregnant women

(0) No intervention

(1) PETRA-A

(2) PETRA-B

(3) PETRA-C

CEA & CUA

[29]

South Africa (UM)

18.10%

8421 pregnant women representing a high prevalence health district (26% HIV+)

(0) No intervention

(1) ACTG 076 with breastfeeding, current infrastructure

(2) ACTG 076 without breastfeeding, enhanced infrastructure

(3) PETRA-A, enhanced infrastructure

CEA

[34]

SSA

1% - 26%

20 000 pregnant women

(0) No intervention

(1) HIVNET 012 (targeted)

(2) HIVNET 012 (universal)

(3) PETRA-A

(4) PETRA-B

(5) CDC Thai (targeted)

CEA & CUA

[30]

South Africa (UM)

18.10%

20 000 pregnant women

(0) No intervention

(1) Formula feeding (FF) recommended from birth

(2) FF recommended from 4 months

(3) FF recommended from 7 months

(4) FF supplied from birth

(5) ACTG 076

(6) PETRA-B

(7) CDC Thai

8) CDC Thai + FF recommended

(9) CDC Thai + FF supplied

CEA

[35]

SSA

1% - 26%

10 000 pregnant women

(0) No intervention

(1) Antenatal HIVNET 012 (targeted)

(2) Antenatal HIVNET 012 (universal)

(3) Labour and delivery universal maternal NVP

(4) Labour and delivery universal infant therapy

CEA

[36]

South Africa (UM)

18.10%

1 340 797 pregnant women (annual national average)

(0) No intervention

(1) CDC Thai (targeted) + FF supplied, enhanced infrastructure

CEA

[37]

South Africa (UM)

18.10%

920 000 HIV+ pregnancies nationally over 5 years

(0) No intervention

(1) 25% HIV+ pregnant women and infants receive ART7

(2) Strategy (1) at 75%

(3) 100% pregnant women (HIV+ and HIV-) receive ART

(4) 3-drug ART of 25% of non-pregnant HIV+ adults

CEA

[23]

Mexico (UM)

0.30%

958 294 pregnant women (national birth cohort)

(0) 4% VCT8 to pregnant women + ACTG 076 or HIVNET 012

(1) Strategy (1) at 85% VCT

(2) 30% VCT to pregnant women at highest risk + ACTG 076 or HIVNET 012

(3) VCT to HIV+ pregnant women + ACTG 076 or HIVNET 012

(4) Strategy (4) plus VCT to 15% of late presenters

CEA

[25]

SSA

1% - 26%

Simulation of national MTCT programs using data from 8 SSA countries

(0) No intervention

(1) HIVNET 012

CEA & CUA

[31]

Zambia (L)

15.20%

40 000 pregnant women

Usual care (UC) = VCT + HIVNET 012

(0) UC + BF for 6 months

(1) UC + BF for 12 months

(2) UC + FF for 12 months

(3) UC + BF for 6 months + daily infant NVP

(4) VCT + Maternal 3-drug ART in pregnancy + 3-drug ART for 6 months BF

(5) Same as (4), but only for women with CD4 < = 200

CUA

[27]

Thailand (LM)

1.40%

100 000 pregnant women

(0) 1 VCT + Maternal and infant ZDV as ACTG 076

(1) 1 VCT + maternal and infant NVP as HIVNET 012

(2) (1) for antenatal care + (2) for late arrivals

(3) 1 VCT + combined ACTG 076 + HIVNET 012

(4) (0) with 2 VCT

(5) (1) with 2 VCT

(6) (2) with 2 VCT

(7) (3) with 2 VCT

CEA

[22]

India (LM)

0.50%

100 000 sexually active women aged 15-49

(0) No intervention

(1) Universal screening in all states + HIVNET 012

(2) Universal screening in 6 highest prevalence states + HIVNET 012

CEA & CUA

[24]

SSA

1% - 26%

100 000 sexually active women aged 15-49

(0) VCT + HIVNET 012 (5% coverage)

(1) VCT + HIVNET 012 (15% coverage)

(2) Family planning (contraceptive use)

CEA

[28]

South Africa (UM)

18.10%

100 000 pregnant women

For strategies 1 - 6, the analysis compared 1 VCT (base case) versus 2 VCT

(1) ACTG 076 (from 28 weeks) + HIVNET 012 + ART to HIV+ve children

(2) As (1) but without ART to HIV+ve children

(3) ACTG 076 (from 34 weeks) + HIVNET 012 + ART to HIV+ve children

(4) As (3) but without ART to HIV+ve children

(5) HIVNET 012 + ART to HIV+ve children

(6) Same as (5) but without ART to HIV+ve children

CUA

[26]

Kenya (L)

8.3%

10 000 pregnant women

(0) Individual VCT

(1) Couple VCT

CEA

[38]

Global, results presented for 14 countries with largest numbers of HIV+ pregnant women

 

1 342 199 HIV+ pregnant women

(0) Antiretroviral therapy (WHO Option A antenatal & intrapartum components)

(1) Strategy 0 for all HIV+ women + Family planning

CEA

[40]

Tanzania (L)

6.2%

12 747 pregnancies in catchment area in 2007 (2% HIV prevalence)

(0) No intervention

(1) HIVNET 012

(2) HAART (WHO Option B)

CEA & CUA

[39]

Malawi (L)

11%

6500 pregnant women

(0) No Intervention

(1) HAART (WHO Option B)

CEA & CUA

  1. 1 According to the 2008 World Bank classification. LMIC = Low and Middle income countries. UM = Upper Middle Income $3,946 - $12,195; LM = Lower Middle Income ($996 - $3,945); L = Low Income ($995 or less) [16].
  2. 2 Source: UNAIDS country epidemiological factsheets HIV prevalence ages 15-49 years 2009.
  3. 3 Hypothetical cohorts, except for two studies [39] and [40] based on specific patient cohorts.
  4. 4 Clinical trials and guidelines are described in Additional file 1. Where possible, we have numbered the base case (comparator) for the analysis as (0).
  5. 5 CEA = Cost Effectiveness Analysis. CUA = Cost Utility Analysis. CBA = Cost Benefit Analysis.
  6. 6 SSA = Sub-Saharan Africa
  7. 7 ART = antiretroviral therapy
  8. 8 VCT = voluntary counselling and testing. According to more recent terminology, all counselling and testing strategies discussed in these papers would now be referred to as "PIHT" or provider-initiated HIV testing.
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Cost Effectiveness and Resource Allocation

ISSN: 1478-7547

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