Comparing Cost-Effectiveness of Strategies for Antenatal Hiv Testing: VCT and Routine Testing in Urban Nigeria

Abstract

Globally, in 2015, 90% of 2.6 million children living with human-immune-deficiency virus (HIV) became infected through mother-to-child-transmission (MTCT). Nigeria has the largest number of new infections with 41,000 and bears one-third of global burden of MTCT. Almost 60% of pregnant women in Nigeria receive antenatal care (ANC) and deliver in hospital; however, uptake of ANC HIV testing with standard voluntary counselling and testing (VCT) is 29%, leaving more than half of sero-positive mothers undiagnosed. Low testing rate weakens the link between prevention of MTCT program. A switch to innovative routine HIV testing warrant settings specific understanding of the cost-effectiveness. This study compares cost effectiveness of two strategies for offering HIV test. A pre-post study was conducted. The pre-test involved administering HIV testing to pregnant women on self-referral voluntary counselling and testing (VCT). In the post-test, the mid-wife offered women group HIV counselling and testing during ANC. HIV testing data involving testing and staff costs were collected, and cost-effectiveness analysis (incremental cost-effectiveness ratio (ICER), cost per new diagnosis and cost of averted cases) were calculated. In comparison, routine testing identified more women living with HIV 44 (15%) against VCT, which identified 15 (10.5%). Routine testing averted 6.60 new HIV infection per year compared to VCT at 3.75. The cost per new diagnosis of HIV in pregnant women was lower for routine testing ($290.86 versus $396.30 per new diagnosis) and similarly, the cost for averted transmission ($1264 versus $1698). The incremental cost-effectiveness ratio (ICER) is $236.31. Evidently, routine HIV testing is economically dominant over VCT; identified more women living with HIV and averted more infections in children. The ICER is below acceptable threshold. A nation-wide adoption of routine testing is recommended for timely identification of sero-positive mothers and reduction of MTCT and associated resources in management of infected children.