Abstract
BackgroundCountries are currently progressing towards the elimination of new paediatric HIV infections by 2015. WHO published new consolidated guidelines in June 2013, which now recommend either ‘Antiretroviral drugs (ARVs) for women living with HIV during pregnancy and breastfeeding (Option B)’ or ‘Lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV (Option B+)’, while de facto phasing out Option A. This study examined health outcomes and cost impact of the shift to WHO 2013 recommendations in Zambia.MethodsA decision analytic model was developed based on the national health system perspective. Estimated risk and number of cases of HIV transmission to infants and to serodiscordant partners, and proportions of HIV-infected pregnant women with CD4 count of ≤350 cells/mm3 to initiate ART were compared between 2010 Option A and the 2013 recommendations. Total costs of prevention of mother-to-child transmission of HIV (PMTCT) services per annual cohort of pregnant women, incremental cost-effectiveness ratio (ICER) per infection averted and quality-adjusted life-year (QALY) gained were examined.ResultsOur analysis suggested that the shift from 2010 Option A to the 2013 guidelines would result in a 33% reduction of the risk of HIV transmission among exposed infants. The risk of transmission to serodiscordant partners for a period of 24 months would be reduced by 72% with ‘ARVs during pregnancy and breastfeeding’ and further reduced by 15% with ‘Lifelong ART’. The probability of HIV-infected pregnant women to initiate ART would increase by 80%. It was also suggested that while the shift would generate higher PMTCT costs, it would be cost-saving in the long term as it spares future treatment costs by preventing infections in infants and partners.ConclusionThe shift to the WHO 2013 guidelines in Zambia would positively impact health of family and save future costs related to care and treatment.
Highlights
Human Immunodeficiency Virus (HIV) can be transmitted from infected mothers to their infants during pregnancy, labour, delivery, and breastfeeding period
In June 2013, World Health Organization (WHO) published new consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, which recommend either ‘Antiretroviral drugs (ARVs) drugs for women living with HIV during pregnancy and breastfeeding (2010 guidelines Option B)’ or ‘Lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV (2010 guidelines Option B+)’, while de facto phasing out Option A [6]
That would represent a 72% reduction in the risk of transmission to serodiscordant partners following a shift from Option A to Option B, while a further reduction of 15% could be expected when shifting from Option B to Option B+
Summary
Human Immunodeficiency Virus (HIV) can be transmitted from infected mothers to their infants during pregnancy, labour, delivery, and breastfeeding period. In June 2013, WHO published new consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, which recommend either ‘ARV drugs for women living with HIV during pregnancy and breastfeeding (2010 guidelines Option B)’ or ‘Lifelong ART for all pregnant and breastfeeding women living with HIV (2010 guidelines Option B+)’, while de facto phasing out Option A [6]. WHO published new consolidated guidelines in June 2013, which recommend either ‘Antiretroviral drugs (ARVs) for women living with HIV during pregnancy and breastfeeding (Option B)’ or ‘Lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV (Option B+)’, while de facto phasing out Option A. This study examined health outcomes and cost impact of the shift to WHO 2013 recommendations in Zambia
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