title: Uptake, outcomes, and costs of antenatal, well-baby, and prevention of mother-to-child transmission of HIV services under routine care conditions in Zambia.
abstract: BACKGROUND
  Zambia adopted Option A for prevention of mother-to-child transmission of HIV (PMTCT) in 2010 and announced a move to Option B+ in 2013. We evaluated the uptake, outcomes, and costs of antenatal, well-baby, and PMTCT services under routine care conditions in Zambia after the adoption of Option A.
  
  
  METHODS
  We enrolled 99 HIV-infected/HIV-exposed (index) mother/baby pairs with a first antenatal visit in April-September 2011 at four study sites and 99 HIV-uninfected/HIV-unexposed (comparison) mother/baby pairs matched on site, gestational age, and calendar month at first visit. Data on patient outcomes and resources utilized from the first antenatal visit through six months postpartum were extracted from site registers. Costs in 2011 USD were estimated from the provider's perspective.
  
  
  RESULTS
  Index mothers presented for antenatal care at a mean 23.6 weeks gestation; 55% were considered to have initiated triple-drug antiretroviral therapy (ART) based on information recorded in site registers. Six months postpartum, 62% of index and 30% of comparison mother/baby pairs were retained in care; 67% of index babies retained had an unknown HIV status. Comparison and index mother/baby pairs utilized fewer resources than under fully guideline-concordant care; index babies utilized more well-baby resources than comparison babies. The average cost per comparison pair retained in care six months postpartum was $52 for antenatal and well-baby services. The average cost per index pair retained was $88 for antenatal, well-baby, and PMTCT services and increased to $185 when costs of triple-drug ART services were included.
  
  
  CONCLUSIONS
  HIV-infected mothers present to care late in pregnancy and many are lost to follow up by six months postpartum. HIV-exposed babies are more likely to remain in care and receive non-HIV, well-baby care than HIV-unexposed babies. Improving retention in care, guideline concordance, and moving to Option B+ will result in increased service delivery costs in the short term.
authors.affiliation: Center for Global Health and Development, Boston University, Boston, Massachusetts, United States of America ; Zambia Center for Applied Health Research and Development, Lusaka, Zambia.
authors.forename: Callie A
authors.initials: CA
authors.lastname: Scott
authors.forename: Hari S
authors.initials: HS
authors.lastname: Iyer
authors.forename: Deophine
authors.initials: D
authors.lastname: Lembela Bwalya
authors.forename: Maximillian
authors.initials: M
authors.lastname: Bweupe
authors.forename: Sydney B
authors.initials: SB
authors.lastname: Rosen
authors.forename: Nancy
authors.initials: N
authors.lastname: Scott
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Larson
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use; D016022:Case-Control Studies; D003140:Communicable Disease Control / Q000191:economics; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000191:economics / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care; D011181:Postnatal Care / Q000191:economics* / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics; D016896:Treatment Outcome; D055815:Young Adult; D015024:Zambia
chemical_list: D019380:Anti-HIV Agents