650: Cost-effectiveness of prenatal HIV screening strategies in Uganda

Abstract

Estimate the cost-effectiveness of HIV screening strategies for the prevention of mother-to-child transmission (MTCT) in Uganda, a resource-limited country with high HIV prevalence and incidence. We designed a decision analytic model from a health care system perspective to assess the cost-effectiveness of 4 different HIV screening strategies in pregnancy: 1. Antibody (Ab) at initial visit (current standard of care); 2. Strategy 1 + RNA at initial visit (adds detection of acute HIV); 3. Strategy 1 + repeat Ab at delivery (adds detection of incident HIV); 4. Strategy 3 + 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-effective threshold as 3 times the gross domestic product per capita, which for Uganda was US$3300 in 2008. Using base case estimates of 10% HIV prevalence among women entering prenatal care and 3% incidence during pregnancy, strategy 3 was incrementally the most cost-effective option. Strategy 3 remained the most cost-effective option in sensitivity analysis until the pregnancy incidence rate was >14%, at which point strategy 4 became cost-effective at <$3, 300 per life-year gained. Repeat HIV Ab testing at time of birth is a cost-effective strategy even in a resource-limited setting. Additionally, adding acute HIV testing becomes cost-effective when HIV incidence is >14% in pregnancy.