title: The cost-effectiveness of repeat HIV testing during pregnancy in a resource-limited setting.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Repeat rapid HIV Ab testing at the time of labor is a cost-effective strategy even in a resource-limited setting such as Uganda.
authors: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA 94143-0132, USA. kimlh@obgyn.ucsf.edu
authors: Lena H
authors: LH
authors: Kim
authors: Deborah L
authors: DL
authors: Cohan
authors: Teresa N
authors: TN
authors: Sparks
authors: Rachel A
authors: RA
authors: Pilliod
authors: Emmanuel
authors: E
authors: Arinaitwe
authors: Aaron B
authors: AB
authors: Caughey
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D015483:HIV Antibodies / Q000097:blood / Q000191:economics; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control / Q000635:transmission*; D015497:HIV-1 / Q000235:genetics / Q000276:immunology; D006295:Health Resources / Q000191:economics; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008403:Mass Screening / Q000191:economics*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000191:economics; D011295:Prenatal Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012367:RNA, Viral / Q000032:analysis; D014454:Uganda
chemical_list: D015483:HIV Antibodies; D012367:RNA, Viral
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