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Frerichs, R.R. Early screening of HIV in pregnant mothers

SEA-AIDS Network, July 15, 1997

Posted in response to:

SEA-AIDS, July 11, 1997

From Jamie Uhrig, UNDP, Hanoi, Vietnam

An 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.

Does anyone know at what level of HIV seroprevalence in pregnant women it becomes cost effective, given current testing and treatment costs in southeast Asia?

Jamie Uhrig, Project Officer - UNDP

UNAIDS, Uy Ban Quoc Gia Phong Chong AIDS

138 Giang Vo

Hanoi Vietnam

R.R. Frerichs Posting

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 programs.

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 volume sales.

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.