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Optimizing HIV Retesting During Pregnancy and Postpartum in Four Countries: A Cost-Effectiveness Analysis

64 Pages Posted: 26 Jun 2020

See all articles by Julianne Meisner

Julianne Meisner

Department of Epidemiology, University of Washington

D Allen Roberts

Department of Epidemiology, University of Washington

Patricia Rodriguez

The Comparative Health Outcomes Policy & Economics Institute,University of Washington

Monisha Sharma

University of Washington, School of Public Health, Department of Global Health

Morkor Newman Owiredu

Global HIV, Hepatitis and STI programme, World Health Organization

Bertha Gomez

Pan American Health Organization/World Health Organization

Maeve B. de Mello

Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization

Alexey Bobrik

Global Fund to Fight AIDS, Tuberculosis and Malaria

Arkadii Vodianyk

Ukraine Country Office, World Health Organization

Andrew Storey

Clinton Health Access Initiative

George Githuka

National AIDS & STI Control Programme

Thato Chidarikire

HIV Prevention Programmes, National Department of Health

Ruanne Barnabas

University of Washington

Shiza Farid

Department of Global Health, University of Washington

Shaffiq Essajee

HIV Section, UNICEF

Muhammad S. Jamil

Global HIV, Hepatitis and STI programme, World Health Organization

Rachel Baggaley

Global HIV, Hepatitis and STI programme, World Health Organization

Cheryl Johnson

Global HIV, Hepatitis and STI programme, World Health Organization

Alison Drake

University of Washington - Department of Global Health

More...

Abstract

Background: HIV retesting during late pregnancy and breastfeeding can help detect new maternal infections and prevent mother-to-child HIV transmission (MTCT), but the optimal timing and cost-effectiveness of maternal retesting is uncertain.

Methods: We constructed Markov models to assess the health and economic impact of maternal HIV retesting, following initial testing in pregnancy, on MTCT in four countries: South Africa and Kenya (high/intermediate HIV prevalence), and Colombia and Ukraine (low HIV prevalence). We evaluated six scenarios with varying retesting frequencies from the second antenatal care visit (ANC) through nine months postpartum. We compared strategies using incremental cost-effectiveness ratios (ICERs) over a 20-year time horizon using country-specific thresholds.

Findings: Maternal retesting once at second ANC with catch-up testing through six weeks postpartum was cost-effective in Kenya (ICER=$166 per DALY averted) and South Africa (ICER=$289 per DALY averted). This strategy prevented 19% (Kenya) and 12% (South Africa) of infant HIV infections. Adding one or two additional retests postpartum provided smaller benefits (1-2% additional infections averted versus one retest). Adding three retests during the postpartum period averted additional infections (1-3% additional infections averted versus one retest) but ICERs ($7,639 and in Kenya and $11,985 in South Africa) greatly exceeded the cost-effectiveness thresholds. In Colombia and Ukraine, all retesting strategies exceeded the cost-effectiveness threshold and prevented few infant infections (up to 31 and 5 infections, respectively).

Interpretation: In high HIV burden settings, HIV retesting once at second ANC, with subsequent intervention, is the most cost-effective strategy for preventing infant HIV infections. In these settings, two HIV retests postpartum marginally reduced MTCT and was less costly than adding three retests. Retesting in Colombia and Ukraine was not cost-effective at any time point due to very low HIV prevalence and limited breastfeeding.

Funding: This study was funded by WHO #201742717, WHO #018/CDS/HIV/004, WHO #2018/865307-0, USAID GHA‐G‐ 00‐09‐00003, and the Bill and Melinda Gates Foundation OPP1177903, and supported by NIH/NIAID P30‐ AI027757, NIH/NIAID K01 AI116298 (ALD), NIH/NIMH K01 MH115789 (MS) and NIH/NIEHS T32 ES015459-09 (JM).

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: Missing.

Keywords: HIV; pregnancy; postpartum; mother-to-child HIV transmission; prevention of mother-to-child HIV transmission; cost effectiveness; maternal and child health

Suggested Citation

Meisner, Julianne and Roberts, D Allen and Rodriguez, Patricia and Sharma, Monisha and Owiredu, Morkor Newman and Gomez, Bertha and de Mello, Maeve B. and Bobrik, Alexey and Vodianyk, Arkadii and Storey, Andrew and Githuka, George and Chidarikire, Thato and Barnabas, Ruanne and Farid, Shiza and Essajee, Shaffiq and Jamil, Muhammad S. and Baggaley, Rachel and Johnson, Cheryl and Drake, Alison, Optimizing HIV Retesting During Pregnancy and Postpartum in Four Countries: A Cost-Effectiveness Analysis (4/5/2020). Available at SSRN: https://ssrn.com/abstract=3571532 or http://dx.doi.org/10.2139/ssrn.3571532

Julianne Meisner

Department of Epidemiology, University of Washington

D Allen Roberts

Department of Epidemiology, University of Washington

Patricia Rodriguez

The Comparative Health Outcomes Policy & Economics Institute,University of Washington

Monisha Sharma

University of Washington, School of Public Health, Department of Global Health ( email )

WA
United States

Morkor Newman Owiredu

Global HIV, Hepatitis and STI programme, World Health Organization

Bertha Gomez

Pan American Health Organization/World Health Organization

Maeve B. De Mello

Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization

Alexey Bobrik

Global Fund to Fight AIDS, Tuberculosis and Malaria

Arkadii Vodianyk

Ukraine Country Office, World Health Organization

Andrew Storey

Clinton Health Access Initiative

George Githuka

National AIDS & STI Control Programme

Thato Chidarikire

HIV Prevention Programmes, National Department of Health

Ruanne Barnabas

University of Washington

Seattle, WA 98195
United States

Shiza Farid

Department of Global Health, University of Washington

Shaffiq Essajee

HIV Section, UNICEF

Muhammad S. Jamil

Global HIV, Hepatitis and STI programme, World Health Organization

Rachel Baggaley

Global HIV, Hepatitis and STI programme, World Health Organization

Cheryl Johnson

Global HIV, Hepatitis and STI programme, World Health Organization

Alison Drake (Contact Author)

University of Washington - Department of Global Health ( email )

Seattle, WA
United States

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