Table 1.
Overview of economic evaluations of interventions to reduce mother to child transmission (MTCT) of HIV
| Study | Location (Income)1 | Adult HIV Prevalence2 | Study Population3 | Interventions4 | Study design5 |
|---|---|---|---|---|---|
| [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 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 Source: UNAIDS country epidemiological factsheets HIV prevalence ages 15-49 years 2009.
3 Hypothetical cohorts, except for two studies [39] and [40] based on specific patient cohorts.
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 CEA = Cost Effectiveness Analysis. CUA = Cost Utility Analysis. CBA = Cost Benefit Analysis.
6 SSA = Sub-Saharan Africa
7 ART = antiretroviral therapy
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.