title: Development and pilot testing of HIV screening program integration within public/primary health centers providing antenatal care services in Maharashtra, India.
abstract: BACKGROUND
  The objectives of this paper are: (1) to study the feasibility and relative benefits of integrating the prevention of parent-to-child transmission (PPTCT) component of the National AIDS Control Program with the maternal and child health component of the National Rural Health Mission (NRHM) by offering HIV screening at the primary healthcare level; and (2) to estimate the incremental cost-effectiveness ratio to understand whether the costs are commensurate with the benefits.
  
  
  METHODS
  The intervention included advocacy with political, administrative/health heads, and capacity building of health staff in Satara district, Maharashtra, India. The intervention also conducted biannual outreach activities at primary health centers (PHCs)/sub-centers (SCs); initiated facility-based integrated counseling and testing centers (FICTCs) at all round-the-clock PHCs; made the existing FICTCs functional and trained PHC nurses in HIV screening. All "functional" FICTCs were equipped to screen for HIV and trained staff provided counseling and conducted HIV testing as per the national protocol. Data were collected pre- and post- integration on the number of pregnant women screened for HIV, the number of functional FICTCs and intervention costs. Trend analyses on various outcome measures were conducted. Further, the incremental cost-effectiveness ratio per pregnant woman screened was calculated.
  
  
  RESULTS
  An additional 27% of HIV-infected women were detected during the intervention period as the annual HIV screening increased from pre- to post-intervention (55% to 79%, p < 0.001) among antenatal care (ANC) attendees under the NRHM. A greater increase in HIV screening was observed in PHCs/SCs. The proportions of functional FICTCs increased from 47% to 97% (p < 0.001). Additionally, 93% of HIV-infected pregnant women were linked to anti-retroviral therapy centers; 92% of mother-baby pairs received Nevirapine; and 89% of exposed babies were enrolled for early infant diagnosis. The incremental cost-effectiveness ratio was estimated at INR 44 (less than 1 US$) per pregnant woman tested.
  
  
  CONCLUSIONS
  Integrating HIV screening with the broader Rural Health Mission is a promising opportunity to scale up the PPTCT program. However, advocacy, sensitization, capacity building and the judicious utilization of available resources are key to widening the reach of the PPTCT program in India and elsewhere.
authors.affiliation: FHI 360, Bandra (East), Mumbai 400051, India. sbindoria@fhi360.org.
authors.forename: Suchitra V
authors.initials: SV
authors.lastname: Bindoria
authors.forename: Ramesh
authors.initials: R
authors.lastname: Devkar
authors.forename: Indrani
authors.initials: I
authors.lastname: Gupta
authors.forename: Virupax
authors.initials: V
authors.lastname: Ranebennur
authors.forename: Niranjan
authors.initials: N
authors.lastname: Saggurti
authors.forename: Sowmya
authors.initials: S
authors.lastname: Ramesh
authors.forename: Dilip
authors.initials: D
authors.lastname: Deshmukh
authors.forename: Sanjeevsingh
authors.initials: S
authors.lastname: Gaikwad
mesh_terms: D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control; D006801:Humans; D007194:India; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008403:Mass Screening / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D010865:Pilot Projects; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000517:prevention & control; D011295:Prenatal Care / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D016730:Program Development / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D011634:Public Health / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012621:Seasons