The cost-effectiveness of repeat HIV testing during pregnancy in a resource-limited setting

Lena H. Kim, Deborah L. Cohan, Teresa N. Sparks, Rachel Pilliod, Emmanuel Arinaitwe, Aaron B. Caughey

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Objective: To estimate the cost-effectiveness of HIV screening strategies for the prevention of perinatal transmission in Uganda, a resource-limited country with high HIV prevalence and incidence. Study Design: We designed a decision analytic model from a health care system perspective to assess the vertical transmission rates and cost-effectiveness of 4 different HIV screening strategies in pregnancy: (1) rapid HIV antibody (Ab) test at initial visit (current standard of care), (2) strategy 1 + HIV RNA at initial visit (adds detection of acute HIV), (3) strategy 1 + repeat HIV Ab at delivery (adds detection of incident HIV), and (4) strategy 3 + HIV RNA at delivery (adds detection of acute HIV at delivery). Model estimates were derived from the literature and local sources, and life years saved were discounted at a rate of 3% per year. Based on World Health Organization guidelines, we defined our cost-effectiveness threshold as #3 times the gross domestic product per capita, which for Uganda was US$3300 in 2008. Results: Using base case estimates of 10% HIV prevalence among women entering prenatal care and 3% incidence during pregnancy, strategy 3 was incrementally the cost-effective option that led to the greatest total life years. Conclusions: Repeat rapid HIV Ab testing at the time of labor is a costeffective strategy even in a resource-limited setting such as Uganda.

Original languageEnglish (US)
Pages (from-to)195-200
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number2
StatePublished - Jun 1 2013


  • Cost-effectiveness analysis
  • Decision analysis
  • HIV
  • Perinatal transmission
  • Pregnancy

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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