Perinatal HIV transmission and the cost-effectiveness of screening at 14 weeks gestation, at the onset of labour and the rapid testing of infants

The objective of this research was to estimate the cost-effectiveness of relevant HIV screening strategies for the antenatal population in the U.S. Virgin Islands. An economic model was used to evaluate the incremental costs and incremental health benefits of nine different combinations of perinatal HIV screening strategies as compared to existing practice from a societal perspective. Three opportunities for screening were considered in isolation and in combination: by 14 weeks gestation, at the onset of labor, or of the infant after birth. The main outcome measure was the cost per life year gained (LYG).Results indicate that all strategies would produce benefits and save costs. Universal screening by 14 weeks gestation and screening the infant after birth is the recommended strategy, with cost savings of $1,122,787 and health benefits of 310 LYG. Limitations include the limited research on the variations in screening acceptance of screening based on specimen sample, race and economic status. The benefits of screening after 14 weeks gestation but before the onset of labor were also not addressed.This study highlights the benefits of offering screening at different opportunities and repeat screening and raises the question of generalizing these results to other countries with similar characteristics.Perinatal transmission causes most HIV infection among new born infants [1]. Transmission occurs during pregnancy, at the time of delivery or through breast milk [2]. The risk of perinatal HIV transmission can be reduced from 13–43% to less than 2% [3-5] if an accurate diagnosis is made and appropriate treatment provided. Universal antenatal screening for HIV in pregnancy is now advocated in a number of countries [6,7] and a number of cost-effectiveness studies have been published [8-12]. These describe high income settings where HIV prevalence is low, prenatal care is widely available and adherence is good and typically screening is offered once during the 1st trimester