A range of measures designed to prevent
transmission of HIV from mother to baby in South African women constitute cost
effective healthcare strategy according to a research team in
Johannesburg.
Using mathematical modelling, the team assessed the
cost effectiveness of four different formula feeding strategies, three
interventions using anti-HIV drugs, and a combination of the two, in a cohort of
20,000 pregnant women in Soweto. Low cost, short-course antiretroviral regimens
were almost as effective as the higher cost regimens such as the ACTG 076
protocol, and more so when combined with formula feeding. Even where women
breast fed, low cost antiretroviral regimens would save both lives and money.
Use of formula feed, on the other hand, would vary in impact according to local
seroprevalence and child survival rates.
According to the South African Department of Health,
more than 1 in 5 women attending antenatal clinics nationally tested
HIV-positive in 1998. As this study’s authors note, "Whereas paediatric HIV
infection is on the verge of being eliminated in the United States, in
sub-Saharan Africa it has become a common cause of admission to hospital and a
major contributor to childhood mortality".
Health Minister Zuma’s decision last year to refuse
Glaxo Wellcome’s offer of discounted AZT for South Africa’s pregnant women on
the grounds that implementing antiretroviral prevention strategies was
unaffordable caused protracted debate. It has been estimated that the costs
involved in setting up and running a programme to provide the short-course
‘CDC-Thai’ regimen – found to a cost effective intervention in this study – to
all HIV-infected pregnant women in South Africa would cost less than 0.5% of the
national health budget.
Research into short-course regimens, and other
interventions applicable to antenatal care in the developing world is discussed
Source: Soderlund N et al. Prevention of vertical
transmission of HIV: analysis of cost effectiveness of options available in
South Africa. BMJ 318:1650-1656, 1999. (Freely available on the BMJ website at
)