Preventing mother-to-baby transmission in South Africa

This article is more than 23 years old.

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

Glossary

antenatal

The period of time from conception up to birth.

cost-effective

Cost-effectiveness analyses compare the financial cost of providing health interventions with their health benefit in order to assess whether interventions provide value for money. As well as the cost of providing medical care now, analyses may take into account savings on future health spending (because a person’s health has improved) and the economic contribution a healthy person could make to society.

mathematical models

A range of complex mathematical techniques which aim to simulate a sequence of likely future events, in order to estimate the impact of a health intervention or the spread of an infection.

protocol

A detailed research plan that describes the aims and objectives of a clinical trial and how it will be conducted.

paediatric

Of or relating to children.

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

at

href="http://www.aidsmap.com/heading3.asp?heading2=Options+during+pregnancy&newBrowse=true">http://www.aidsmap.com/heading3.asp?heading2=Options+during+pregnancy&newBrowse=true

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

href="http://www.bmj.com/cgi/content/full/318/7199/1650">http://www.bmj.com/cgi/content/full/318/7199/1650

)