title: Cost-effectiveness of a repeat HIV test in pregnancy in India.
abstract: OBJECTIVE
  To evaluate cost-effectiveness of second HIV test in pregnancy.
  
  
  BACKGROUND
  Current strategy of single HIV test during pregnancy in India can miss new HIV infections acquired after the first test or those HIV infections that were missed in the first test due to a false-negative HIV test.
  
  
  METHODS
  Between August 2011 and April 2013, 9097 pregnant HIV uninfected women were offered a second HIV test near term (34 weeks or beyond) or within 4 weeks of postpartum period. A decision analysis model was used to evaluate cost-effectiveness of a second HIV test in pregnant women near term.
  
  
  METHODS
  Our key outcome measures include programme cost with addition of second HIV test in pregnant women and quality-adjusted life years (QALYs) gained.
  
  
  RESULTS
  We detected 4 new HIV infections in the second test. Thus HIV incidence among pregnant women was 0.12 (95% 0.032 to 0.297) per 100 person women years (PWY). Current strategy of a single HIV test is 8.2 times costlier for less QALYs gained as compared to proposed repeat HIV testing of pregnant women who test negative during the first test.
  
  
  CONCLUSIONS
  Our results warrant consideration at the national level for including a second HIV test of all pregnant women in the national programme. However prior to allocation of resources for a second HIV test in pregnancy, appropriate strategies will have to be planned for improving compliance for prevention of mother-to-child transmission of HIV and reducing loss-to-follow-up of those women detected with HIV.
  
  
  BACKGROUND
  CTRI/2013/12/004183.
authors.affiliation: Department of Preventive Oncology, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, Maharashtra, India.
authors.forename: Smita
authors.initials: S
authors.lastname: Joshi
authors.affiliation: Prayas Health Group, Amrita Clinic, Pune, Maharashtra, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Kulkarni
authors.affiliation: National AIDS Research Institute, Pune, Maharashtra, India.
authors.forename: Raman
authors.initials: R
authors.lastname: Gangakhedkar
authors.affiliation: Department of Preventive Oncology, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, Maharashtra, India.
authors.forename: Uma
authors.initials: U
authors.lastname: Mahajan
authors.affiliation: MIMER Hospital, Pune, Maharashtra, India.
authors.forename: Sushma
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Kamla Nehru Hospital, Pune Municipal Corporation, Pune, Maharashtra, India.
authors.forename: Devendra
authors.initials: D
authors.lastname: Shirole
authors.affiliation: Indian Council of Medical Research, New Delhi, India.
authors.forename: Nomita
authors.initials: N
authors.lastname: Chandhiok
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008403:Mass Screening; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000453:epidemiology; D011295:Prenatal Care; D019057:Quality-Adjusted Life Years; D055815:Young Adult
keywords: EPIDEMIOLOGY