Stringer J S, Rouse D J, Vermund S H, Goldenberg R L, Sinkala M, Stinnett A A
Department of Obstetrics and Gynecology, School of Medicine, University of Alabama at Birmingham, Birmingham, USA.
J Acquir Immune Defic Syndr. 2000 Aug 1;24(4):369-77. doi: 10.1097/00126334-200008010-00012.
To assess the cost-effectiveness of alternative strategies of nevirapine (NVP) administration to prevent vertical HIV transmission in sub-Saharan Africa.
A decision-analysis model was constructed to estimate the costs and effects of NVP-based prevention strategies for two separate groups of women: those who qualify for standard therapy by attending a 36-week prenatal visit, and those who do not qualify, owing to preterm delivery or lack of prenatal care.
For women in prenatal care, mass provision of NVP without maternal serodiagnosis was found to yield greater health gains at an acceptable cost, compared with providing targeted therapy to only those women identified as seropositive. However, this conclusion was strongly contingent on several uncertain assumptions, most importantly the probability that a woman who does not know her serostatus will nonetheless adhere to therapy. Among those women who present for delivery without prior enrollment in a prenatal strategy, either late provision of maternal-infant NVP or treatment of only the infant would likely be a cost-effective alternative to the current practice of offering no preventive therapy.
NVP intervention offers a cost-effective avenue for preventing vertical HIV transmission in sub-Saharan Africa. The optimal choice between mass therapy and targeted therapy cannot be confidently identified without information regarding adherence among women who do not know their serostatus. For women who do not receive NVP prenatally, treatment on presentation for delivery would be cost-effective even in the face of modest clinical efficacy. Clinical assessment of adherence to therapy among women who do not know their status and the field effectiveness of alternative approaches to NVP administration is urgently needed to allow identification of optimal prevention strategies.
评估在撒哈拉以南非洲地区采用奈韦拉平（NVP）不同给药策略预防HIV垂直传播的成本效益。
构建了一个决策分析模型，以估算基于NVP的预防策略对两组不同女性群体的成本和效果：一组是通过参加36周产前检查符合标准治疗条件的女性，另一组是由于早产或缺乏产前护理而不符合条件的女性。
对于接受产前护理的女性，发现与仅向血清学检测呈阳性的女性提供靶向治疗相比，在不进行母亲血清学诊断的情况下大规模提供NVP能以可接受的成本带来更大的健康收益。然而，这一结论很大程度上取决于几个不确定的假设，最重要的是，不知道自己血清学状态的女性坚持治疗的概率。在那些未事先参与产前策略而前来分娩的女性中，要么晚期提供母婴NVP，要么仅治疗婴儿，这可能是比目前不提供预防性治疗的做法更具成本效益的选择。
NVP干预为撒哈拉以南非洲地区预防HIV垂直传播提供了一条具有成本效益的途径。如果没有关于血清学状态未知女性坚持治疗情况的信息，就无法确定大规模治疗和靶向治疗之间的最佳选择。对于产前未接受NVP的女性，即使临床疗效一般，分娩时进行治疗也具有成本效益。迫切需要对血清学状态未知女性的治疗依从性进行临床评估，以及评估NVP给药替代方法的实际效果，以便确定最佳预防策略。
