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Cost-effectiveness of dual maternal HIV and syphilis testing strategies in high and low HIV prevalence countries: a modelling study.

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  • Additional Information
    • Source:
      Publisher: Elsevier Ltd Country of Publication: England NLM ID: 101613665 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2214-109X (Electronic) Linking ISSN: 2214109X NLM ISO Abbreviation: Lancet Glob Health Subsets: MEDLINE
    • Publication Information:
      Original Publication: [England] : Elsevier Ltd. 2013-
    • Subject Terms:
      Cost-Benefit Analysis/*statistics & numerical data ; HIV Infections/*diagnosis ; HIV Infections/*epidemiology ; Pregnancy Complications, Infectious/*diagnosis ; Prenatal Diagnosis/*methods ; Syphilis/*diagnosis; Adult ; Colombia/epidemiology ; Cost-Benefit Analysis/economics ; Cost-Benefit Analysis/methods ; Female ; HIV Infections/economics ; Humans ; Infectious Disease Transmission, Vertical/economics ; Infectious Disease Transmission, Vertical/prevention & control ; Kenya/epidemiology ; Markov Chains ; Models, Theoretical ; Pregnancy ; Pregnancy Complications, Infectious/economics ; Prenatal Diagnosis/economics ; Prevalence ; South Africa/epidemiology ; Syphilis/economics ; Ukraine/epidemiology
    • Abstract:
      Background: Dual HIV and syphilis testing might help to prevent mother-to-child transmission (MTCT) of HIV and syphilis through increased case detection and treatment. We aimed to model and assess the cost-effectiveness of dual testing during antenatal care in four countries with varying HIV and syphilis prevalence.
      Methods: In this modelling study, we developed Markov models of HIV and syphilis in pregnant women to estimate costs and infant health outcomes of maternal testing at the first antenatal care visit with individual HIV and syphilis tests (base case) and at the first antenatal care visit with a dual rapid diagnostic test (scenario one). We additionally evaluated retesting during late antenatal care and at delivery with either individual tests (scenario two) or a dual rapid diagnosis test (scenario three). We modelled four countries: South Africa, Kenya, Colombia, and Ukraine. Strategies with an incremental cost-effectiveness ratio (ICER) less than the country-specific cost-effectiveness threshold (US$500 in Kenya, $750 in South Africa, $3000 in Colombia, and $1000 in Ukraine) per disability-adjusted life-year averted were considered cost-effective.
      Findings: Routinely offering testing at the first antenatal care visit with a dual rapid diagnosis test was cost-saving compared with the base case in all four countries (ICER: -$26 in Kenya,-$559 in South Africa, -$844 in Colombia, and -$454 in Ukraine). Retesting during late antenatal care with a dual rapid diagnostic test (scenario three) was cost-effective compared with scenario one in all four countries (ICER: $270 in Kenya, $260 in South Africa, $2207 in Colombia, and $205 in Ukraine).
      Interpretation: Incorporating dual rapid diagnostic tests in antenatal care can be cost-saving across countries with varying HIV prevalence. Countries should consider incorporating dual HIV and syphilis rapid diagnostic tests as the first test in antenatal care to support efforts to eliminate MTCT of HIV and syphilis.
      Funding: WHO, US Agency for International Development, and the Bill & Melinda Gates Foundation.
      (© 2021 This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.)
    • Comments:
      Comment in: Lancet Glob Health. 2021 May;9(5):e595. (PMID: 33865469)
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    • Grant Information:
      T32 HS013853 United States HS AHRQ HHS; K01 MH115789 United States MH NIMH NIH HHS; T32 ES015459 United States ES NIEHS NIH HHS; K01 AI116298 United States AI NIAID NIH HHS; P30 AI027757 United States AI NIAID NIH HHS; 001 International WHO_ World Health Organization
    • Publication Date:
      Date Created: 20201123 Date Completed: 20210127 Latest Revision: 20231110
    • Publication Date:
      20240105
    • Accession Number:
      PMC7783487
    • Accession Number:
      10.1016/S2214-109X(20)30395-8
    • Accession Number:
      33227254