Bristow Claire C, Larson Elysia, Anderson Laura J, Klausner Jeffrey D
Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA.
Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
Sex Transm Infect. 2016 Aug;92(5):340-6. doi: 10.1136/sextrans-2015-052367. Epub 2016 Feb 26.
The WHO called for the elimination of maternal-to-child transmission (MTCT) of HIV and syphilis, a harmonised approach for the improvement of health outcomes for mothers and children. Testing early in pregnancy, treating seropositive pregnant women and preventing syphilis reinfection can prevent MTCT of HIV and syphilis. We assessed the health and economic outcomes of a dual testing strategy in a simulated cohort of 100 000 antenatal care patients in Malawi.
We compared four screening algorithms: (1) HIV rapid test only, (2) dual HIV and syphilis rapid tests, (3) single rapid tests for HIV and syphilis and (4) HIV rapid and syphilis laboratory tests. We calculated the expected number of adverse pregnancy outcomes, the expected costs and the expected newborn disability-adjusted life years (DALYs) for each screening algorithm. The estimated costs and DALYs for each screening algorithm were assessed from a societal perspective using Markov progression models. Additionally, we conducted a Monte Carlo multiway sensitivity analysis, allowing for ranges of inputs.
Our cohort decision model predicted the lowest number of adverse pregnancy outcomes in the dual HIV and syphilis rapid test strategy. Additionally, from the societal perspective, the costs of prevention and care using a dual HIV and syphilis rapid testing strategy was both the least costly ($226.92 per pregnancy) and resulted in the fewest DALYs (116 639) per 100 000 pregnancies. In the Monte Carlo simulation the dual HIV and syphilis algorithm was always cost saving and almost always reduced DALYs compared with HIV testing alone.
The results of the cost-effectiveness analysis showed that a dual HIV and syphilis test was cost saving compared with all other screening strategies. Updating existing prevention of mother-to-child HIV transmission programmes in Malawi and similar countries to include dual rapid testing for HIV and syphilis is likely to be advantageous.
世界卫生组织呼吁消除艾滋病毒和梅毒的母婴传播，这是一种改善母婴健康结局的统一方法。孕期早期检测、治疗血清学阳性孕妇以及预防梅毒再感染可预防艾滋病毒和梅毒的母婴传播。我们在马拉维一个模拟的10万名产前护理患者队列中评估了双重检测策略的健康和经济结局。
我们比较了四种筛查算法：（1）仅进行艾滋病毒快速检测，（2）艾滋病毒和梅毒双重快速检测，（3）艾滋病毒和梅毒单项快速检测，（4）艾滋病毒快速检测和梅毒实验室检测。我们计算了每种筛查算法的不良妊娠结局预期数量、预期成本以及预期新生儿残疾调整生命年（DALYs）。使用马尔可夫进展模型从社会角度评估每种筛查算法的估计成本和DALYs。此外，我们进行了蒙特卡洛多因素敏感性分析，考虑了输入范围。
我们的队列决策模型预测，艾滋病毒和梅毒双重快速检测策略中的不良妊娠结局数量最少。此外，从社会角度来看，采用艾滋病毒和梅毒双重快速检测策略的预防和护理成本最低（每次妊娠226.92美元），且每10万次妊娠导致的DALYs最少（116,639）。在蒙特卡洛模拟中，与单独进行艾滋病毒检测相比，艾滋病毒和梅毒双重算法始终具有成本效益，并且几乎总是能减少DALYs。
成本效益分析结果表明，与所有其他筛查策略相比，艾滋病毒和梅毒双重检测具有成本效益。在马拉维和类似国家更新现有的预防母婴艾滋病毒传播计划，纳入艾滋病毒和梅毒双重快速检测可能是有益的。
