Integrated approach for triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis is highly effective and cost-effective: an economic evaluation

作者：Lei Zhang, Yusha Tao, Joseph Woodring, Rattana Kim, Sovannarith Samreth, Tung Rathavy, Kannitha Cheang, Shafiqul Hossain, Laurent Ferradini, Serongkea Deng, Chay Sokun, Chham Samnang, Mari Nagai, Ying-Ru Lo, Naoko Ishikawa · 发表于：International Journal of Epidemiology · 年份：2019 · DOI：10.1093/ije/dyz037 · 被引用次数：56 · 研究领域：HIV/AIDS Research and Interventions、Adolescent Sexual and Reproductive Health、HIV, Drug Use, Sexual Risk

BACKGROUND: The Regional Framework for Triple Elimination of Mother-to-Child Transmission (EMTCT) of HIV, Hepatitis B (HBV) and Syphilis in Asia and the Pacific 2018-30 was endorsed by the Regional Committee of WHO Western Pacific in October 2017, proposing an integrated and coordinated approach to achieve elimination in an efficient, coordinated and sustainable manner. This study aims to assess the population impacts and cost-effectiveness of this integrated approach in the Cambodian context. METHODS: Based on existing frameworks for the EMTCT for each individual infection, an integrated framework that combines infection prevention procedures with routine antenatal care was constructed. Using decision tree analyses, population impacts, cost-effectiveness and the potential reduction in required resources of the integrated approach as a result of resource pooling and improvements in service coverage and coordination, were evaluated. The tool was assessed using simulated epidemiological data from Cambodia. RESULTS: The current prevention programme for 370,000 Cambodian pregnant women was estimated at USD$2.3 ($2.0-$2.5) million per year, including the duration of pregnancy and up to 18 months after delivery. A model estimate of current MTCT rates in Cambodia was 6.6% (6.2-7.1%) for HIV, 14.1% (13.1-15.2%) for HBV and 9.4% (9.0-9.8%) for syphilis. Integrating HIV and syphilis prevention into the existing antenatal care framework will reduce the total time required to provide thi...