Should HIV testing for all pregnant women continue? Cost‐effectiveness of universal antenatal testing compared to focused approaches across high to very low HIV prevalence settings

Ishikawa, Naoko; Dalal, Shona; Johnson, Cheryl; Hogan, Daniel R; Shimbo, Takuro; Shaffer, Nathan; Pendse, Razia; Lo, Ying-Ru; Ghidinelli, Massimo; Baggaley, Rachel

doi:10.7448/ias.19.1.21212

Cited by 25 publications

(16 citation statements)

References 12 publications

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“…However, more than 80% of Ethiopian population resides in rural areas [ 29 ], as a result large number of HIV positive women will be left undiagnosed if rural women have no access to HIV testing. Moreover, different studies demonstrated that universal HIV testing of pregnant women is more cost saving and cost effective in different HIV epidemic contexts as compared to targeted HIV testing approaches [ 30 – 32 ].…”

Section: Discussionmentioning

confidence: 99%

HIV testing during pregnancy for prevention of mother-to-child transmission of HIV in Ethiopia

Ejigu

Tadesse

2018

PLoS ONE

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IntroductionHIV testing during pregnancy provides an entry point to prevention of mother-to-child transmission of HIV and to access treatment for HIV positive women. The study aimed to assess the uptake of HIV testing during pregnancy and associated factors among Ethiopian women.MethodsWe analyzed the 2016 Ethiopian Demographic and Health Survey dataset. Women who gave birth within one year prior to the survey were included in the analysis. Uptake of HIV testing during pregnancy is defined as receiving HIV testing service during pregnancy and/or at the time of delivery and knew the test results. Adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) were calculated by using step-wise backward logistic regression analyses to identify factors associated with HIV testing during pregnancy.ResultsA total of 2114 women who were pregnant in the last one year prior to the survey were included in the analysis. Of these, only 35.1% were tested for HIV and received the test results during pregnancy. About one third of women who had antenatal care follow-up missed the opportunity to be tested for HIV. Compared to women who had no formal education, those who had primary level education (AOR = 1.55; 95% CI: 1.12–2.15), secondary level education (AOR = 2.56 95%CI: 1.36–3.82), or higher education (AOR = 3.95, 95%CI: 1.31–11.95) were more likely to be tested for HIV during pregnancy. Similarly, having awareness about mother-to-child transmission of HIV (AOR = 2.03, 95%CI: 1.48–2.78), and living in urban areas (AOR = 3.30, 95%CI: 1.39–7.85) were positively and independently associated with uptake of HIV during pregnancy. Women who have stigmatizing attitude towards HIV positive people were less likely to be tested for HIV (AOR = 0.57, 95%CI: 0.40–0.79).ConclusionUptake of HIV testing during pregnancy is low. Missed opportunity among women who had antenatal care visits was very high. Integrating HIV testing with antenatal care services, improving HIV testing service quality and access are essential to increase uptake of HIV testing during pregnancy and reach the goal of eliminating MTCT.

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Section: Discussionmentioning

confidence: 99%

HIV testing during pregnancy for prevention of mother-to-child transmission of HIV in Ethiopia

Ejigu

Tadesse

2018

PLoS ONE

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“…This finding suggests that a universal HIV-testing strategy should be implemented to achieve the national target of elimination of HIV transmission from mother to child by 2030. Universal testing may require initial investments, but it has been shown to be cost-effective even in a low and concentrated HIV epidemic country such as Vietnam [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Monitoring Prevention Impact of Mother-to-Child Transmission of HIV in Concentrated Epidemics With Program and Survey Data

Nguyen¹,

Sabin²,

et al. 2017

JMIR Public Health Surveill

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BackgroundThe prevention of mother-to-child transmission (PMTCT) of HIV program was introduced in Vietnam in 2005. Despite the scaling up of PMTCT programs, the rate of mother-to-child HIV transmission in Vietnam was estimated as high as 20% in 2013.ObjectiveThe objective of this study was to assess the outcomes of PMTCT and identified factors associated with mother-to-child transmission and infant survival using survey and program data in a high HIV burden province in Vietnam.MethodsThis community-based retrospective cohort study observed pregnant women diagnosed with HIV infection in Thai Nguyen province from October 2008 to December 2012. Data were collected through interviews using a structured questionnaire and through reviews of log books and medical charts in antenatal care and HIV clinics. Logistic regression and survival analysis were used to analyze data using Stata (StataCorp).ResultsA total of 172 pregnant women living with HIV were identified between 2008 and 2012. Most of these women had acquired the HIV infection from their husband (77/119, 64.7%). Significant improvement in the PMTCT program was documented, including reduction in late diagnosis of HIV for pregnant women from 62.5% in 2008 to 30% in 2012. Access to antiretrovirals (ARVs) improved, increasing from a rate of 18.2% (2008) to 70.0% (2011) for mothers and from 36.4% (2008) to 93.3% (2012) for infants. For infants, early diagnosis within 2 months of birth reached 66.7% in 2012 compared with 16.7% in 2009. Transmission rate reduced from 27.3% in 2008 to 6.7% in 2012. Late diagnosis was associated with increased risk for HIV transmission (odds ratio [OR] 14.7, 95% CI 1.8-121.4, P=.01), whereas ARV therapy for mother and infant in combination with infant formula feeding were associated with reduced risk for HIV transmission (OR 0.01, 95% CI 0.001-0.1; P<.001). Overall survival rate for HIV-exposed infants at 12 months was 97.7%.ConclusionsA combination of program and survey data measured the impact of prevention of HIV transmission from mother-to-child interventions. Significant improvement in access to the interventions was documented in Thai Nguyen province. However, factors that increased the risk of HIV transmission, such as late diagnosis, remain to be addressed.

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“…Estimated rates of MTCT (including the breastfeeding period up to 36 months) per country were obtained from the 2016 UNAIDS Spectrum model estimates or other published sources. We developed categories for both HIV prevalence and MTCT as follows: very low (<1%), low (1% to 5%), intermediate (>5% to <15%) and high (≥15%) based on previous work by Ishikawa and colleagues .…”

Section: Methodsmentioning

confidence: 99%

Retest and treat: a review of national HIV retesting guidelines to inform elimination of mother‐to‐child HIV transmission (EMTCT) efforts

et al. 2019

Self Cite

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Introduction High maternal HIV incidence contributes substantially to mother‐to‐child HIV transmission ( MTCT ) in some settings. Since 2006, HIV retesting during the third trimester and breastfeeding has been recommended by the World Health Organization in higher prevalence (≥5%) settings to reduce MTCT . However, many countries lack clarity on when and how often to retest pregnant and postpartum women to optimize resources and service delivery. We reviewed and characterized national guidelines on maternal retesting based on timing and frequency. Methods We identified 52 countries to represent variations in HIV prevalence, geography, and MTCT priority and searched available national MTCT , HIV testing and HIV treatment policies published between 2007 and 2017 for recommendations on retesting during pregnancy, labour/delivery and postpartum. Recommended retesting frequency and timing was extracted. Country HIV prevalence was classified as: very low (<1%), low (1% to 5%), intermediate (>5 to <15%) and high (≥15%). Women with unknown HIV status at delivery/postpartum were included in retesting guidelines. Results and discussion Overall, policies from 49 countries were identified; 51% from 2015 or later and most (n = 25) were from Africa. Four countries were high HIV prevalence, seven intermediate, sixteen low and twenty‐two very low. Most (n = 31) had guidance on universal voluntary opt‐out HIV testing at the first antenatal care ( ANC ) visit. Beyond the first ANC visit, the majority (78%, n = 38) had guidance on retesting; 22 recommended retesting all women with unknown/negative status, five only if unknown HIV status, three in pregnancy based on risk and eight combining these approaches. Retesting was universally recommended during pregnancy, labour/delivery, and postpartum for all high prevalence settings and four of seven intermediate prevalence settings. Five UNAIDS priority countries for EMTCT with low/very low HIV prevalence, but high/intermediate MTCT , had no guidance on retesting. Conclusions Retesting guidelines for pregnant and postpartum women were ubiquitous in high prevalence countries and defined in some intermediate prevalence countries, but absent in some low HIV prevalence countries with high MTCT . Countries may require additional guidance on how to optimize mate...

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Should HIV testing for all pregnant women continue? Cost‐effectiveness of universal antenatal testing compared to focused approaches across high to very low HIV prevalence settings

Cited by 25 publications

References 12 publications

HIV testing during pregnancy for prevention of mother-to-child transmission of HIV in Ethiopia

HIV testing during pregnancy for prevention of mother-to-child transmission of HIV in Ethiopia

Monitoring Prevention Impact of Mother-to-Child Transmission of HIV in Concentrated Epidemics With Program and Survey Data

Retest and treat: a review of national HIV retesting guidelines to inform elimination of mother‐to‐child HIV transmission (EMTCT) efforts

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