Early screening of HIV in pregnant mothers.
SEA-AIDS Network, July 15,
Posted in response to:
Jamie Uhrig, UNDP, Hanoi, Vietnam
interesting question has come up in discussions in Vietnam that relates to the ongoing sea-AIDS Link debate about early HIV testing.
HIV screening for pregnant women in order to offer them zidovudine
treatment to prevent perinatal transmission is clearly cost effective in
high prevalence situations. It is not cost effective in low prevalence situations.
anyone know at what level of HIV seroprevalence in pregnant women it
becomes cost effective, given current testing and treatment costs in southeast Asia?
Uhrig, Project Officer - UNDP
Uy Ban Quoc Gia Phong Chong AIDS
I am responding to the posting of Jamie Uhrig from Vietnam on screening
of pregnant women. Usually countries establish sentinel surveillance systems
that at first are comprised only of high risk groups (e.g., drug addicts,
commercial sex workers, and STD clinic attendees) and then once the virus
is found to be present, include low risk groups (e.g., women attending
antenatal clinics, military recruits). Once the sentinel surveillance system
finds that the prevalence of HIV is rising among pregnant women, then the
decision should be made to screen all pregnant women. The cost and effectiveness
would be easy to model for different prevalence levels (i.e., 0.5%, 1.0%,
1.5%, 2.0%), but the findings may be hard to interpret without knowing
the value that the society places in saving an infant's life, or the benefits
that come in the local society from alternative intervention or prevention
Screening programs should not be started if there is no indication that
the virus has spread to pregnant women. The treatment costs depend on the
procedure that is followed (i.e., more expensive as done in the United
States, or less expensive as is now being evaluated in Thailand), and the
price of zidovudine that groups such as UNAIDS could negotiate with higher
Asian countries that likely would benefit from screening of pregnant
women are areas of India, Myanmar, Thailand (especially the Northern regions),
Cambodia and possibly Laos. Other areas that should establish multi-site
sentinel surveillance programs to watch and warn are Southern China, Vietnam,
the Philippines, Malaysia, Singapore and Indonesia.