Cost variations in prevention of mother-to-child HIV transmission services integrated within maternal and child health services in rural Tanzania

Farida Hassan,Seema Vyas,Jenny Renju,Lameck B Luwanda,Deborah Kajoka,Alison Wringe,Prosper Njau,Lorna Guinness

doi:10.1080/17441692.2020.1798486

Abstract

ABSTRACT We estimated the costs of Option B+ for HIV-infected pregnant women in 12 facilities in Morogoro Region, Tanzania, from a provider perspective. Costs of prevention of mother-to-child (PMTCT) HIV services were measured over 12 months to September 2017 to estimate the average costs per HIV testing episode, per HIV-positive case diagnosed, per patient-year on antiretroviral therapy (ART), and per neonatal HIV care. A one-way sensitivity analysis was undertaken to understand how staffing levels and other core resource inputs affected costs. The total number of HIV testing episodes was 25,593 with 279 HIV cases identified yielding a 1.1% positivity rate. The average cost per testing episode was US$5.49 (range US$2.13 to US$13.93), and the average cost per HIV case detected was US$503.29 (range US$230.61 to US$3330.38). The number of pregnant women initiated on ART was 278. The mean cost per patient-year on ART was US$159.89 (range US$100.91 to US$812.23). The average cost of neonatal HIV care was US$90.09 (range US$41.53 to US$180.26). PMTCT service costs varied widely across facilities due to variations in resource use, number of women testing, and HIV prevalence. The study provides further evidence against generalising cost estimates, and that budgeting and planning requires context specific cost information.

Highlights

IntroductionThe provision of anti-retroviral treatment (ART) to pregnant women based on CD4 cell count and clinical staging (e.g. Options A and B), contributed to a global decline in the number of infants becoming HIV-infected through their mothers from 400,000 to 240,000 between 2009 and 2013 (World Health Organization, 2014)
The provision of anti-retroviral treatment (ART) to pregnant women based on CD4 cell count and clinical staging (e.g. Options A and B), contributed to a global decline in the number of infants becoming HIV-infected through their mothers from 400,000 to 240,000 between 2009 and 2013 (World Health Organization, 2014).Global initiatives, including the World Health Organization’s (WHO) recommendation of Option B+, lifelong HIV treatment for all pregnant women living with HIV, as the favoured strategy in the prevention mother-to-child transmission (PMTCT) (WHO, 2012) have kept PMTCT high on the international agenda
This study estimates the costs of PMTCT, under Option B+, delivered within routine maternal and child health services, across12 health facilities serving the population of the Ifakara health and demographic surveillance system (HDSS) in Morogoro Region

Summary

Introduction

The provision of anti-retroviral treatment (ART) to pregnant women based on CD4 cell count and clinical staging (e.g. Options A and B), contributed to a global decline in the number of infants becoming HIV-infected through their mothers from 400,000 to 240,000 between 2009 and 2013 (World Health Organization, 2014). Global initiatives, including the World Health Organization’s (WHO) recommendation of Option B+, lifelong HIV treatment for all pregnant women living with HIV, as the favoured strategy in the prevention mother-to-child transmission (PMTCT) (WHO, 2012) have kept PMTCT high on the international agenda. Pregnant women living with HIV with sustained and lifelong HIV treatment, and to reduce the annual number of newly infected children to less than 40,000 by the end of 2018 (UNAIDS, 2017). Model-based studies, which are typically based on normative guidance, estimated that in the long-run Option B+ would be more cost-effective when compared to previous PMTCT mechanisms of Options A and B (Fasawe et al, 2013; Gopalappa et al, 2014; Ishikawa et al, 2014)

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