Coomes David M, Meisner Julianne, Roberts D Allen, Rodriguez Patricia, Owiredu Morkor Newman, Sharma Monisha, Bobrik Alexey, Vodianyk Arkadii, Williams Amanda, Githuka George, Chidarikire Thato, Barnabas Ruanne V, Farid Shiza, Essajee Shaffiq, Jamil Muhammad S, Baggaley Rachel, Johnson Cheryl C, Drake Alison L
Department of Epidemiology, University of Washington, Seattle, WA, USA.
Department of Global Health, University of Washington, Seattle, WA, USA.
J Acquir Immune Defic Syndr. 2025 Jun 4. doi: 10.1097/QAI.0000000000003700.
Key populations, including female sex workers (FSW), people who inject drugs (PWID), and people in serodiscordant partnerships, experience higher HIV incidence compared to the general population. Maternal HIV retesting, particularly during late pregnancy, helps detect new infections and prevent vertical HIV transmission, but optimal testing schedules among key populations are unknown.
We used a Markov model to estimate the health and economic impacts of maternal HIV retesting on vertical HIV transmission outcomes among FSW and PWID in Kenya, South Africa, and pre-war Ukraine as well as among pregnant people in serodiscordant partnerships in Kenya and South Africa. We calculated incremental cost-effectiveness ratios (ICERs) for seven maternal retesting scenarios that included HIV testing during early antenatal care (ANC) and retesting from late ANC through nine months postpartum.
Retesting during late ANC was estimated to avert 16% (Kenya), 14% (South Africa), and 8% (Ukraine) of infant HIV infections among key populations. Retesting during late ANC was cost-saving or cost-effective among all populations included in our model in South Africa and Kenya. In Ukraine, HIV retesting during late ANC was cost-saving for PWID but not cost-effective for FSW. Postpartum retesting was not cost-effective in any population.
Maternal HIV retesting during late ANC is cost-saving or cost-effective for vertical HIV transmission outcomes for pregnant key populations and serodiscordant couples in Kenya and South Africa and is cost-saving for PWID in Ukraine.
包括女性性工作者、注射吸毒者以及血清学不一致伴侣在内的重点人群，其艾滋病毒感染率高于普通人群。孕产妇艾滋病毒重新检测，尤其是在妊娠晚期进行检测，有助于发现新感染病例并预防艾滋病毒垂直传播，但重点人群中的最佳检测时间表尚不清楚。
我们使用马尔可夫模型来估计孕产妇艾滋病毒重新检测对肯尼亚、南非和战前乌克兰的女性性工作者及注射吸毒者以及肯尼亚和南非血清学不一致伴侣中的孕妇的艾滋病毒垂直传播结果的健康和经济影响。我们计算了七种孕产妇重新检测方案的增量成本效益比（ICER），这些方案包括在早期产前护理（ANC）期间进行艾滋病毒检测以及从晚期ANC到产后九个月进行重新检测。
据估计，在晚期ANC期间重新检测可避免重点人群中16%（肯尼亚）、14%（南非）和8%（乌克兰）的婴儿感染艾滋病毒。在我们模型纳入的南非和肯尼亚的所有人群中，晚期ANC期间重新检测具有成本节约或成本效益。在乌克兰，晚期ANC期间的艾滋病毒重新检测对注射吸毒者具有成本节约效果，但对女性性工作者不具有成本效益。产后重新检测在任何人群中都不具有成本效益。
在肯尼亚和南非，晚期ANC期间的孕产妇艾滋病毒重新检测对于怀孕重点人群和血清学不一致夫妇的艾滋病毒垂直传播结果具有成本节约或成本效益，在乌克兰对注射吸毒者具有成本节约效果。
