AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #383 - Is elimination of pediatric HIV affordable? An appraisal in three sub-Saharan countries
Authors: Presenting Author: Dr Hapsatou Toure - ISPED
Additional Authors: Dr Martine Audibert, Ms Patricia Doughty, Dr Virginie Ettiegne Traore, Mr Cedric Limbo, Dr Jules Mugabo, Dr Chewe Luo, Dr Francois Dabis,
Aim: Resource-limited countries are increasingly scaling up interventions for prevention of mother-to-child HIV transmission (PMTCT) towards virtual elimination of pediatric HIV. Modifications to treatment and prophylaxis recommended in the 2010 World Health Organization (WHO) guidelines should, however, place a significant additional burden on existing health systems. In light of the global economical crisis, data on the costs of providing PMTCT are needed to estimate the amount of additional resources needed to scale up those services within the context of the Millennium Development Goals (MDGs).
Method / Issue: In 2009–2010, using a health-care provider perspective, we conducted cost analyses at 30 public-sector maternal, neonatal and child health facilities providing free comprehensive PMTCT services in Côte d’Ivoire, Namibia and Rwanda. Information on prices and volume of services was collected from national government bodies, international donor partners, and non-governmental organizations. PMTCT package includes HIV testing and counseling, male partner testing, CD4 testing, antiretroviral prophylaxis provision, community-based activities, exposed-infant prophylaxis at birth, and 2-years post-partum family planning. Only direct costs borne are included. Costs are expressed in 2009 US$. Outcomes are cost per-pregnancy and nation-wide total program cost, subdivided by major cost categories. We ultimately simulated the expected costs over time according to different PMTCT coverage levels and adoption of 2010 WHO recommendations. Analysis horizon is year 2015. Future costs are discounted at a 3% rate.
Results / Comments: Costs per mother-infant couple in Côte d’Ivoire/Rwanda are respectively $394.96/$286.87 for 2006 WHO recommendations (ART being provided throughout 18 months of breastfeeding) compared to $199.59/$339.41 for 2010 WHO Option A and $671.63/$314.67 for 2010 WHO Option B regimens. Given current PMTCT services coverage and uptake levels, nation-wide estimates are $3,140,451.00/$5,259,114.19 compared to respectively $13,365,360.87/$8,705,281.47 and $22,306,490.69/$8,397,481.97 for Option A and Option B adopted at 95% service coverage. The intervention is associated with an incremental cost of $1,791.67/$4,064.98 and $3,358.39/$3,701.91 per vertical infection averted. Over the 2010-2015 period, it is $102,411,572.19/$66,703,890.00 or $170,922,641.31/$64,345,387.98 that will be needed to implement Option A or Option B and achieve virtual pediatric HIV elimination. Management and supervision costs share in the total cost drops as the level of service uptake increase. Compared to current practice, yearly per capita total population cost will rise from $0.54/$0.15 to $0.90/$0.65 for Option A and $0.86/$1.08 for Option B at optimal coverage levels.
Discussion: A national PMTCT program aiming to eliminate pediatric HIV infection would cost a small fraction of the national health budget. This information is needed to guide policy decisions on the allocation of limited health care resources, and provide a basis to estimate the resource requirements for scaling-up and sustaining those services in the future.
Go Back