Perinatal HIV Infection and the Effect of Zidovudine Therapy on Transmission in Rural and Urban Counties

Fiscus, Susan A.; Adimora, Adaora A.; Schoenbach, Victor J.; Lim, Wilma; McKinney, Ross E.; Rupar, David; Kenny, Jean F.; Woods, Charles R.; Wilfert, Catherine M.

doi:10.1001/jama.1996.03530430027034

Cited by 131 publications

(46 citation statements)

References 15 publications

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“…31 To determine the range of acceptance rates for the sensitivity analysis, we used acceptance rates from women who came for services to the Chicago Department of Public Health Sexually Transmitted Disease Clinics and were offered HIV testing 32 and acceptance rates from other published reports in the medical literature. [33][34][35][36][37] The acceptance of AZT by pregnant women after they are told their HIV status is based on estimates from published studies and results obtained from the University of Illinois Women's Health Clinic 14,38,39 (M. Vajaranant, personal communication, August 1998).…”

Section: Probability Estimatesmentioning

confidence: 99%

Cost-Effectiveness of Universal Compared With Voluntary Screening for Human Immunodeficiency Virus Among Pregnant Women in Chicago

et al. 2000

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ABSTRACT.Objectives. To determine and compare the cost-effectiveness of implementing 3 screening strategies to detect human immunodeficiency virus (HIV) infection among pregnant women in Chicago, Illinois: no screening, voluntary screening, and universal screening.Methods. A decision-analysis model was developed, using standard cost-effectiveness analysis from a societal perspective. Reference case estimates were derived from a surveillance project conducted by the Illinois Department of Public Health and studies were published in the medical literature. Costs included direct and indirect medical costs associated with identification of pregnant women infected with HIV and identification, prevention, and treatment of perinatally HIV-infected newborns. Specifically, for each screening option, the cost per pregnant woman screened, the resulting number of pediatric HIV infections, and the number of newborn life-years were calculated. All costs were adjusted to the 1997 dollar value and discounted at 3%. Sensitivity analyses were determined for all variables included in the decision model.Results. The estimated prevalence of HIV infection among pregnant women in Chicago is .41%. For every 100 000 pregnant women, it is estimated that 104.6 children would be infected with HIV if no screening strategy were implemented and 44.8 children would be infected if voluntary HIV testing (assuming a 92.7% acceptance rate) were available. In comparison, if universal HIV testing was performed, the number of children infected with HIV would decrease to 40 cases. Sensitivity analysis across a maternal HIV prevalence rate of .01% to 2.2% found that universal screening would be cost-saving in communities where the seroprevalence is .21%. In Chicago, it would take an estimated 5.2 months of screening pregnant women to avert 1 case of pediatric HIV. Taking into consideration the lifetime costs of treating a child with HIV infection, universal HIV testing of 100 000 pregnant women would result in a cost-savings of $3.69 million when compared with no screening, and $269 445 when compared with voluntary screening. We estimated that it would cost $11.1 million to screen 100 000 pregnant women in Chicago. The cost-savings produced with increased screening are the direct result of reduced cases of newborns infected with HIV. A 2-way sensitivity analysis was performed to examine how costs vary as a function of the voluntary rates for HIV-positive and HIVnegative women. When screening falls below 50% for HIV-positive mothers, universal screening becomes cheaper than voluntary screening even if no HIV-negative mothers were screened.Conclusion. Reference case analyses showed that universal HIV screening of pregnant women in Chicago would both decrease the number of HIV-infected newborns and save money in comparison to voluntary or no testing strategies. Sensitivity analysis was robust across all variables for the conclusion that universal screening was more effective than voluntary screening. For many communities that have HIV prevalence rates for...

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Section: Probability Estimatesmentioning

confidence: 99%

Cost-Effectiveness of Universal Compared With Voluntary Screening for Human Immunodeficiency Virus Among Pregnant Women in Chicago

et al. 2000

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“…The study provided proof of the principle that anti-retroviral drug prophylaxis can reduce mother-to-child HIV transmission. Uptake of the regimen in clinical practice in the U.S. and Europe has been remarkable, and has been coincident with dramatic declines in new HIV infections among children (Fiscus et al, 1996;Centres for Disease Control and Prevention, 1993Lindegren et al, 1999).…”

Section: Benefits Of Anti-retroviral Drugsmentioning

confidence: 99%

Beyond informed choice: Infant feeding dilemmas for women in low‐resource communities of high HIV prevalence

Kuhn

2002

Social Dynamics

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Short regimens of anti-retroviral drugs can significantly reduce the transmission of HIV from mother to child which occurs around the time of delivery, but these drugs do not significantly reduce HIV transmission through breast-feeding.In order to prevent transmission, some have called for the provision of milk formula for HIV-positive women.However, linking milk formula, which is of questionable safety, with anti-retroviral drugs, which are of known benefit, may be dangerous. It may also delay implementation of programmes which provide wider access to anti-retroviral drugs, as well as making access to these drugs contingent (implicitly or explicitly) on willingness to use formula.Implementing international guidelines which support giving HIV-positive women an informed choice between infant feeding alternatives is difficult in practice. The focus on a dichotomised choice has the effect of neglecting to make each choice safer. New findings suggest that the magnitude of HIV transmission associated with breast-feeding can be substantially reduced with optimal breast-feeding practices, including those which maintain the exclusivity of breast-feeding and prevent the development of breast problems. These new findings have created greater awareness of the quality of breast-feeding and have drawn attention to serious deficiencies in the counseling services which assist women regarding lactation issues within maternal and child health services in general, and within programmes aimed at the prevention of mother-to-child HIV transmission in particular.Even if access to anti-retroviral drugs can be improved, training and motivation of counsellors will remain a cornerstone of programmes which are effective in preventing transmission of HIV to children.

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“…The regimen followed by American Control Trial Group (ATCG 076) using zidovudine monotherapy aims to intervene at all possible stages of transmission Le, antenatal, intrapartum, postpartum & neonatal. Zidovudine has consistently resulted in reductions of 65-75% in infant infections with no immediate serious consequences to the mother, infant, or child development during the first two years of life [19]. Zidovudine significantly decreases the likelihood of vertical tranmission at all observed levels of maternal HIY viral load [20].…”

Section: Perinatal Transmissionmentioning

confidence: 99%

Therapy and Prophylaxis in Human Immunodeficiency Virus (Hiv) Infection

Rao

Gupta

Ohri

1999

Medical Journal Armed Forces India

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Perinatal HIV Infection and the Effect of Zidovudine Therapy on Transmission in Rural and Urban Counties

Cited by 131 publications

References 15 publications

Cost-Effectiveness of Universal Compared With Voluntary Screening for Human Immunodeficiency Virus Among Pregnant Women in Chicago

Cost-Effectiveness of Universal Compared With Voluntary Screening for Human Immunodeficiency Virus Among Pregnant Women in Chicago

Beyond informed choice: Infant feeding dilemmas for women in low‐resource communities of high HIV prevalence

Therapy and Prophylaxis in Human Immunodeficiency Virus (Hiv) Infection

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