Cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa

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 Af...

Full description

Saved in:
Bibliographic Details
Published in:PloS one 2019-11, Vol.14 (11), p.e0225104-e0225104
Main Authors: Dugdale, Caitlin M, Phillips, Tamsin K, Myer, Landon, Hyle, Emily P, Brittain, Kirsty, Freedberg, Kenneth A, Cunnama, Lucy, Walensky, Rochelle P, Zerbe, Allison, Weinstein, Milton C, Abrams, Elaine J, Ciaranello, Andrea L
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adult
AIDS
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Antiretroviral Therapy, Highly Active
Biology and Life Sciences
Breast feeding
Breastfeeding & lactation
Child
Child health
Children
Childrens health
Clinical trials
Comparative analysis
Computer simulation
Cost-Benefit Analysis
Costs
Economic aspects
Economic impact
Female
Health
Health aspects
Health care costs
Health care industry
Health services
Highly active antiretroviral therapy
HIV
HIV infections
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV patients
Human immunodeficiency virus
Humans
Impact analysis
Infant
Infant Care
Infants
Life expectancy
Life span
Male
Maternal-Child Health Services
Medical economics
Medicine and Health Sciences
Pediatric HIV infections
Pediatrics
People and Places
Postnatal Care
Postpartum
Pregnancy
Social Sciences
South Africa - epidemiology
Therapy
Womens health
Young Adult
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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. 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
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0225104