Open AccessCost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa
Author(s) -
Caitlin M Dugdale,
Tamsin K Phillips,
Landon Myer,
Emily P Hyle,
Kirsty Brittain,
Kenneth A. Freedberg,
Lucy Cunnama,
Rochelle P. Walensky,
Allison Zerbe,
Milton C. Weinstein,
Elaine J. Abrams,
Andrea Ciaranello
Publication year - 2019
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0225104
Subject(s) - medicine , breastfeeding , pregnancy , referral , pediatrics , health care , antiretroviral therapy , obstetrics , human immunodeficiency virus (hiv) , viral load , family medicine , genetics , economics , biology , economic growth
Background Poor engagement in postpartum maternal HIV care is a challenge worldwide and contributes to adverse maternal outcomes and vertical transmission. Our objective was to project the clinical and economic impact of integrated postpartum maternal antiretroviral therapy (ART) and pediatric care in South Africa. Methods Using the CEPAC computer simulation models, parameterized with data from the Maternal and Child Health–Antiretroviral Therapy (MCH-ART) randomized controlled trial, we evaluated the cost-effectiveness of integrated postpartum care for women initiating ART in pregnancy and their children. We compared two strategies: 1) standard of care ( SOC ) referral to local clinics after delivery for separate standard ART services for women and pediatric care for infants, and 2) the MCH-ART intervention ( MCH-ART ) of co-located maternal/pediatric care integrated in Maternal and Child Health (MCH) services throughout breastfeeding. Trial-derived inputs included: 12-month maternal retention in care and virologic suppression ( SOC : 49%, MCH-ART : 67%), breastfeeding duration ( SOC : 6 months, MCH-ART : 8 months), and postpartum healthcare costs for mother-infant pairs ( SOC : $50, MCH-ART : $69). Outcomes included pediatric HIV infections, maternal and infant life expectancy (LE), lifetime HIV-related per-person costs, and incremental cost-effectiveness ratios (ICERs; ICER