Kim, L.H., Cohan, D.L., Sparks, T.N., et al. Journal of Acquired Immune Deficiency Syndromes (June 2013), Vol. 63 No. 2, pp. 195-200.
The authors assessed the cumulative cost-effectiveness of three HIV testing strategies, compared to standard care, for the prevention of perinatal transmission in Uganda. The four strategies assessed were: 1) standard of care–rapid HIV antibody testing at the first prenatal visit; 2) standard of care plus HIV RNA (viral load) at initial visit; 3) standard of care plus repeat HIV antibody testing at delivery; and 4) strategy 3 plus HIV RNA at delivery. The results indicated that repeat rapid HIV testing at delivery (strategy 3) was cost-effective and led to the greatest total maternal and child life-years saved. The authors applied a decision analytic model from a health care system perspective to follow a hypothetical cohort of 10,000 Ugandan women in antenatal care. Life-years saved for each strategy were: 414,227 (strategy 1); 414,296 (strategy 2); 415,765 (strategy 3); and 415,794 (strategy 4). Standard care was least expensive. Applying the World Health Organization’s definition (≤3 times the gross domestic product per capita) as the cost-effectiveness threshold, strategy 3 was the most economical option in terms of life-years and remained so in univariate sensitivity analysis. Yet when HIV incidence was more than 8 percent, strategy 4 became the most cost-effective strategy. The findings should inform policies on HIV testing during pregnancy in sub-Saharan Africa.