Patrick D M, Money D M, Forbes J, Dobson S R, Rekart M L, Cook D A, Middleton P J, Burdge D R
British Columbia Centre for Disease Control Society, Vancouver.
CMAJ. 1998 Oct 20;159(8):942-7.
The objectives of this study were to assess the effect of British Columbia's June 1994 guidelines for prenatal HIV screening on the rate of maternal-fetal HIV transmission and to estimate the cost-effectiveness of such screening.
The authors conducted a retrospective review of pregnancy and delivery statistics, HIV screening practices, laboratory testing volume, prenatal and labour management decisions of HIV-positive women, maternal-fetal transmission rates and associated costs.
Over 1995 and 1996, 135,681 women were pregnant and 92,645 carried to term. The rate of HIV testing increased from 55% to 76% of pregnancies on chart review at one hospital between November 1995 and November 1996. On the basis of seroprevalence studies, an estimated 50.2 pregnancies and 34.3 (95% confidence interval 17.6 to 51.0) live births to HIV-positive women were expected. Of 42 identified mother-infant pairs with an estimated date of delivery during 1995 or 1996, 25 were known only through screening. Of these 25 cases, there were 10 terminations, 1 spontaneous abortion and 14 cases in which the woman elected to carry the pregnancy to term with antiretroviral therapy. There was one stillbirth. One instance of maternal-fetal HIV transmission occurred among the 13 live births. The net savings attributable to prevented infections among babies carried to term were $165,586, with a saving per prevented case of $75,266.
A routine offer of pregnancy screening for HIV in a low-prevalence setting reduces the rate of maternal-fetal HIV transmission and may rival other widely accepted health care expenditures in terms of cost-effectiveness.
本研究的目的是评估1994年6月不列颠哥伦比亚省的产前HIV筛查指南对母婴HIV传播率的影响，并估计这种筛查的成本效益。
作者对妊娠和分娩统计数据、HIV筛查实践、实验室检测量、HIV阳性女性的产前和分娩管理决策、母婴传播率及相关成本进行了回顾性研究。
在1995年和1996年期间，有135,681名女性怀孕，92,645名妊娠至足月。在一家医院，1995年11月至1996年11月期间，根据图表回顾，HIV检测率从妊娠的55%增加到76%。根据血清流行率研究，预计有50.2例妊娠以及34.3例（95%置信区间为17.6至51.0）HIV阳性女性的活产。在1995年或1996年估计分娩日期的42对母婴中，有25对仅通过筛查被发现。在这25例中，有10例终止妊娠，1例自然流产，14例女性选择在接受抗逆转录病毒治疗的情况下将妊娠维持至足月。有1例死产。在13例活产中有1例发生母婴HIV传播。足月分娩婴儿中因预防感染而节省的净费用为165,586美元，每预防一例节省75,266美元。
在低流行环境中常规提供HIV妊娠筛查可降低母婴HIV传播率，并且在成本效益方面可能与其他广泛接受的医疗保健支出相当。
