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


Autoři: Caitlin M. Dugdale aff001;  Tamsin K. Phillips aff004;  Landon Myer aff004;  Emily P. Hyle aff001;  Kirsty Brittain aff004;  Kenneth A. Freedberg aff001;  Lucy Cunnama aff008;  Rochelle P. Walensky aff001;  Allison Zerbe aff009;  Milton C. Weinstein aff007;  Elaine J. Abrams aff009;  Andrea L. Ciaranello aff001
Působiště autorů: Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America aff001;  Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America aff002;  Harvard Medical School, Boston, MA, United States of America aff003;  Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa aff004;  Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa aff005;  Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America aff006;  Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America aff007;  Health Economics Unit, School of Public Health & Family Medicine, University of Cape Town, South Africa aff008;  ICAP at Columbia and the Mailman School of Public Health, Columbia University, New York, NY, United States of America aff009;  College of Physicians & Surgeons, Columbia University, New York, NY, United States of America aff010
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0225104

Souhrn

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 <US$903/YLS considered “cost-effective”).

Results

Compared to SOC, MCH-ART increased maternal LE (SOC: 25.26 years, MCH-ART: 26.20 years) and lifetime costs (SOC: $9,912, MCH-ART: $10,207; discounted). Projected pediatric outcomes for all HIV-exposed children were similar between arms, although undiscounted LE for HIV-infected children was shorter in SOC (SOC: 23.13 years, MCH-ART: 23.40 years). Combining discounted maternal and pediatric outcomes, the ICER was $599/YLS.

Conclusion

Co-located maternal HIV and pediatric care, integrated in MCH services throughout breastfeeding, is a cost-effective strategy to improve maternal and pediatric outcomes and should be implemented in South Africa.

Klíčová slova:

Cost-effectiveness analysis – Infants – Pediatric infections – Pediatrics – South Africa


Zdroje

1. UNAIDS. AIDSInfo [cited 2019 August 26]. Available from: http://aidsinfo.unaids.org/.

2. Knettel BA, Cichowitz C, Ngocho JS, Knippler ET, Chumba LN, Mmbaga BT, et al. Retention in HIV care during pregnancy and the postpartum period in the option B+ era: A systematic review and meta-analysis of studies in Africa. J Acquir Immune Defic Syndr. 2017. doi: 10.1097/QAI.0000000000001616 29287029

3. Chetty T, Newell ML, Thorne C, Coutsoudis A. Viraemia before, during and after pregnancy in HIV-infected women on antiretroviral therapy in rural KwaZulu-Natal, South Africa, 2010–2015. Trop Med Int Health. 2018;23(1):79–91. doi: 10.1111/tmi.13001 29121445

4. Haas AD, Tenthani L, Msukwa MT, Tal K, Jahn A, Gadabu OJ, et al. Retention in care during the first 3 years of antiretroviral therapy for women in Malawi's option B+ programme: an observational cohort study. Lancet HIV. 2016;3(4):e175–82. doi: 10.1016/S2352-3018(16)00008-4 27036993

5. Phillips T, Thebus E, Bekker LG, McIntyre J, Abrams EJ, Myer L. Disengagement of HIV-positive pregnant and postpartum women from antiretroviral therapy services: a cohort study. J Int AIDS Soc. 2014;17:19242. doi: 10.7448/IAS.17.1.19242 25301494

6. Kiragu K, Collins L, Von Zinkernagel D, Mushavi A. Integrating PMTCT Into maternal, newborn, and child health and related services: experiences from the global plan priority countries. J Acquir Immune Defic Syndr. 2017;75 Supplem(1):S36–S42.

7. Winestone LE, Bukusi EA, Cohen CR, Kwaro D, Schmidt NC, Turan JM. Acceptability and feasibility of integration of HIV care services into antenatal clinics in rural Kenya: a qualitative provider interview study. Glob Public Health. 2012;7(2):149–63. doi: 10.1080/17441692.2011.621964 22043837

8. Myer L, Phillips TK, Zerbe A, Brittain K, Lesosky M, Hsiao NY, et al. Integration of postpartum healthcare services for HIV-infected women and their infants in South Africa: A randomised controlled trial. PLoS Med. 2018;15(3):e1002547. doi: 10.1371/journal.pmed.1002547 29601570

9. Ciaranello AL, Morris BL, Walensky RP, Weinstein MC, Ayaya S, Doherty K, et al. Validation and calibration of a computer simulation model of pediatric HIV infection. PLoS One. 2013;8(12):e83389. doi: 10.1371/journal.pone.0083389 24349503

10. Walensky RP, Ross EL, Kumarasamy N, Wood R, Noubary F, Paltiel AD, et al. Cost-effectiveness of HIV treatment as prevention in serodiscordant couples. N Engl J Med. 2013;369(18):1715–25. doi: 10.1056/NEJMsa1214720 24171517

11. Dunning L, Francke JA, Mallampati D, MacLean RL, Penazzato M, Hou T, et al. The value of confirmatory testing in early infant HIV diagnosis programmes in South Africa: A cost-effectiveness analysis. PLoS Med. 2017;14(11):e1002446. Detailed description of how CEPAC follows ISPOR guidelines for analyzing and reporting the impact of uncertainty are in the online Table S2 accompanying this manuscript. doi: 10.1371/journal.pmed.1002446 29161262

12. Massachusetts General Hospital Medical Practice Evaluation Center. Cost-Effectiveness of Preventing AIDS Complications (CEPAC) Model [cited 2018 November 30]. Available from: http://www.massgeneral.org/mpec/cepac/.

13. Mandelbrot L, Tubiana R, Le Chenadec J, Dollfus C, Faye A, Pannier E, et al. No perinatal HIV-1 transmission from women with effective antiretroviral therapy starting before conception. Clin Infect Dis. 2015;61(11):1715–25. doi: 10.1093/cid/civ578 26197844

14. Myer L, Phillips TK, McIntyre JA, Hsiao NY, Petro G, Zerbe A, et al. HIV viraemia and mother-to-child transmission risk after antiretroviral therapy initiation in pregnancy in Cape Town, South Africa. HIV Med. 2017;18(2):80–8. doi: 10.1111/hiv.12397 27353189

15. Shapiro RL, Hughes MD, Ogwu A, Kitch D, Lockman S, Moffat C, et al. Antiretroviral regimens in pregnancy and breast-feeding in Botswana. N Engl J Med. 2010;362(24):2282–94. doi: 10.1056/NEJMoa0907736 20554983

16. Perry ME, Taylor GP, Sabin CA, Conway K, Flanagan S, Dwyer E, et al. Lopinavir and atazanavir in pregnancy: comparable infant outcomes, virological efficacies and preterm delivery rates. HIV Med. 2016;17(1):28–35. doi: 10.1111/hiv.12277 26200570

17. Kesho Bora Study Group. Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial. Lancet Infect Dis. 2011;11(3):171–80. doi: 10.1016/S1473-3099(10)70288-7 21237718

18. Cohan D, Natureeba P, Koss CA, Plenty A, Luwedde F, Mwesigwa J, et al. Efficacy and safety of lopinavir/ritonavir versus efavirenz-based antiretroviral therapy in HIV-infected pregnant Ugandan women. AIDS. 2015;29(2):183–91. doi: 10.1097/QAD.0000000000000531 25426808

19. Peltier CA, Ndayisaba GF, Lepage P, van Griensven J, Leroy V, Pharm CO, et al. Breastfeeding with maternal antiretroviral therapy or formula feeding to prevent HIV postnatal mother-to-child transmission in Rwanda. AIDS. 2009;23(18):2415–23. doi: 10.1097/QAD.0b013e32832ec20d 19730349

20. Ngoma MS, Misir A, Mutale W, Rampakakis E, Sampalis JS, Elong A, et al. Efficacy of WHO recommendation for continued breastfeeding and maternal cART for prevention of perinatal and postnatal HIV transmission in Zambia. J Int AIDS Soc. 2015;18:19352. doi: 10.7448/IAS.18.1.19352 26140453

21. Kilewo C, Karlsson K, Massawe A, Lyamuya E, Swai A, Mhalu F, et al. Prevention of mother-to-child transmission of HIV-1 through breast-feeding by treating infants prophylactically with lamivudine in Dar es Salaam, Tanzania: the Mitra Study. J Acquir Immune Defic Syndr. 2008;48(3):315–23. doi: 10.1097/QAI.0b013e31816e395c 18344879

22. Thomas TK, Masaba R, Borkowf CB, Ndivo R, Zeh C, Misore A, et al. Triple-antiretroviral prophylaxis to prevent mother-to-child HIV transmission through breastfeeding—the Kisumu Breastfeeding Study, Kenya: a clinical trial. PLoS Med. 2011;8(3):e1001015. doi: 10.1371/journal.pmed.1001015 21468300

23. Chigwedere P, Seage GR, Lee TH, Essex M. Efficacy of antiretroviral drugs in reducing mother-to-child transmission of HIV in Africa: a meta-analysis of published clinical trials. AIDS Res Hum Retroviruses. 2008;24(6):827–37. doi: 10.1089/aid.2007.0291 18544018

24. Iliff PJ, Piwoz EG, Tavengwa NV, Zunguza CD, Marinda ET, Nathoo KJ, et al. Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS. 2005;19(7):699–708. doi: 10.1097/01.aids.0000166093.16446.c9 15821396

25. Fawzi W, Msamanga G, Spiegelman D, Renjifo B, Bang H, Kapiga S, et al. Transmission of HIV-1 through breastfeeding among women in Dar es Salaam, Tanzania. J Acquir Immune Defic Syndr. 2002;31(3):331–8. doi: 10.1097/00126334-200211010-00010 12439210

26. Petra Study Team. Efficacy of three short-course regimens of zidovudine and lamivudine in preventing early and late transmission of HIV-1 from mother to child in Tanzania, South Africa, and Uganda (Petra study): a randomised, double-blind, placebo-controlled trial. The Lancet. 2002;359(9313):1178–86. doi: 10.1016/s0140-6736(02)08214-4

27. Leroy V, Karon JM, Alioum A, Ekpini ER, Meda N, Greenberg AE, et al. Twenty-four month efficacy of a maternal short-course zidovudine regimen to prevent mother-to-child transmission of HIV-1 in West Africa. AIDS. 2002;16(4):631–41. doi: 10.1097/00002030-200203080-00016 11873008

28. Dabis F, Bequet L, Ekouevi DK, Viho I, Rouet F, Horo A, et al. Field efficacy of zidovudine, lamivudine and single-dose nevirapine to prevent peripartum HIV transmission. AIDS. 2005;19(3):309–18. 15718842

29. Thior I, Lockman S, Smeaton LM, Shapiro RL, Wester C, Heymann SJ, et al. Breastfeeding plus infant zidovudine prophylaxis for 6 months vs formula feeding plus infant zidovudine for 1 month to reduce mother-to-child HIV transmission in Botswana: a randomized trial: the Mashi Study. JAMA. 2006;296(7):794–805. doi: 10.1001/jama.296.7.794 16905785

30. Kuhn L, Aldrovandi GM, Sinkala M, Kankasa C, Semrau K, Mwiya M, et al. Effects of early, abrupt weaning on HIV-free survival of children in Zambia. N Engl J Med. 2008;359(2):130–41. doi: 10.1056/NEJMoa073788 18525036

31. Clinton Health Access Initiative. Antiretroviral CHAI reference price list 2016 [cited 2019 August 26]. Available from: https://clintonhealthaccess.org/content/uploads/2016/11/2016-CHAI-ARV-Reference-Price-List_FINAL.pdf.

32. Cleary S, Chitha W, Jikwana S, Okorafor OA, Boulle A. Health systems trust: South African health review. 2005.

33. Sanders GD, Neumann PJ, Basu A, Brock DW, Feeny D, Krahn M, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: Second panel on cost-effectiveness in health and medicine. JAMA. 2016;316(10):1093–103. doi: 10.1001/jama.2016.12195 27623463

34. Marseille E, Larson B, Kazi DS, Kahn JG, Rosen S. Thresholds for the cost-effectiveness of interventions: alternative approaches. Bull World Health Organ. 2015;93(2):118–24. doi: 10.2471/BLT.14.138206 25883405

35. South Africa Department of Health. National consolidated guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents, and adults. 2015. [cited: 26 August 2019]. Available from: http://www.sahivsoc.org/Files/ART%20Guidelines%2015052015.pdf.

36. International Monetary Fund. World Economic Outlook Database, April 2017 Edition [cited 2019 August 26]. Available from: https://www.imf.org/external/pubs/ft/weo/2017/02/weodata/index.aspx.

37. Oanda. Historical Exchange Rates, Period Average [cited 2019 August 26]. Available from: http://www.oanda.com/currency/historical-rates/.

38. Briggs AH, Weinstein MC, Fenwick EA, Karnon J, Sculpher MJ, Paltiel AD, et al. Model parameter estimation and uncertainty analysis: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force Working Group-6. Med Decis Making. 2012;32(5):722–32. doi: 10.1177/0272989X12458348 22990087

39. Aliyu MH, Blevins M, Audet CM, Kalish M, Gebi UI, Onwujekwe O, et al. Integrated prevention of mother-to-child HIV transmission services, antiretroviral therapy initiation, and maternal and infant retention in care in rural north-central Nigeria: a cluster-randomised controlled trial. Lancet HIV. 2016;3(5):e202–11. doi: 10.1016/S2352-3018(16)00018-7 27126487

40. Guillaine N, Mwizerwa W, Odhiambo J, Hedt-Gauthier BL, Hirschhorn LR, Mugwaneza P, et al. A novel combined mother-infant clinic to optimize post-partum maternal retention, service utilization, and linkage to services in HIV care in rural Rwanda. Int J MCH AIDS. 2017;6(1):36–45. doi: 10.21106/ijma.186 28798892

41. Haas AD, Zaniewski E, Anderegg N, Ford N, Fox MP, Vinikoor M, et al. Retention and mortality on antiretroviral therapy in sub-Saharan Africa: collaborative analyses of HIV treatment programmes. J Int AIDS Soc. 2018;21(2). doi: 10.1002/jia2.25084 29479867

42. Chammartin F, Zurcher K, Keiser O, Weigel R, Chu K, Kiragga AN, et al. Outcomes of Patients Lost to Follow-up in African Antiretroviral Therapy Programs: Individual Patient Data Meta-analysis. Clin Infect Dis. 2018;67(11):1643–52. doi: 10.1093/cid/ciy347 29889240

43. Arikawa S, Rollins N, Jourdain G, Humphrey J, Kourtis AP, Hoffman I, et al. Contribution of maternal ART and breastfeeding to 24-month survival in HIV-exposed uninfected children: an individual pooled analysis of African and Asian studies. Clin Infect Dis. 2017. doi: 10.1093/cid/cix1102 29272387

44. Kalk E, Kroon M, Boulle A, Osler M, Euvrard J, Stinson K, et al. Neonatal and infant diagnostic HIV-PCR uptake and associations during three sequential policy periods in Cape Town, South Africa: a longitudinal analysis. J Int AIDS Soc. 2018;21(11):e25212. doi: 10.1002/jia2.25212 30480373

45. World Health Organization. Updates on HIV and infant feeding. Geneva, Switzerland 2016. [cited: July 17, 2019]. Available from: https://apps.who.int/iris/bitstream/handle/10665/246260/9789241549707-eng.pdf;jsessionid=723C97C531D5147D5B72B3514C35213E?sequence=1.

46. Flynn PM, Taha TE, Cababasay M, Fowler MG, Mofenson LM, Owor M, et al. Prevention of HIV-1 transmission through breastfeeding: efficacy and safety of maternal antiretroviral therapy versus infant nevirapine prophylaxis for duration of breastfeeding in HIV-1-infected women with high CD4 cell count (IMPAACT PROMISE): a randomized, open-label, clinical trial. J Acquir Immune Defic Syndr. 2018;77(4):383–92. doi: 10.1097/QAI.0000000000001612 29239901

47. Goga AE, Jackson DJ, Lombard C, Ramokolo V, Ngandu N, Sherman G, et al. Highest risk of mother to child transmission of HIV or death in the first 6 months postpartum: results from 18 month follow-up of an HIV-exposed national cohort, South Africa. AIDS; Durban, South Africa, 2016. [cited: 2019 August 25]. Available from: http://programme.aids2016.org/Programme/Session/992.

48. Woods B, Revill P, Sculpher M, and Claxton K. Country-level cost-effectiveness thresholds: Initial estimates and the need for further research. Centre for Health Economics, University of York, UK, 2015.].

49. Robinson LA, Hammitt JK, Chang AY, Resch S. Understanding and improving the one and three times GDP per capita cost-effectiveness thresholds. Health Policy Plan. 2017;32(1):141–5. doi: 10.1093/heapol/czw096 27452949

50. Meyer-Rath G, van Rensburg C, Larson B, Jamieson L, Rosen S. Revealed willingness-to-pay versus standard cost-effectiveness thresholds: Evidence from the South African HIV Investment Case. PLoS One. 2017;12(10):e0186496. doi: 10.1371/journal.pone.0186496 29073167

51. Chapman RH, Berger M, Weinstein MC, Weeks JC, Goldie S, Neumann PJ. When does quality-adjusting life-years matter in cost-effectiveness analysis? Health Econ. 2004;13(5):429–36. doi: 10.1002/hec.853 15127423

52. Francke JA, Penazzato M, Hou T, Abrams EJ, MacLean RL, Myer L, et al. Clinical impact and cost-effectiveness of diagnosing HIV infection during early infancy in South Africa: test timing and frequency. The Journal of infectious diseases. 2016;214(9):1319–28. doi: 10.1093/infdis/jiw379 27540110

53. Zulliger R, Black S, Holtgrave DR, Ciaranello AL, Bekker LG, Myer L. Cost-effectiveness of a package of interventions for expedited antiretroviral therapy initiation during pregnancy in Cape Town, South Africa. AIDS and behavior. 2014;18(4):697–705. doi: 10.1007/s10461-013-0641-7 24122044

54. Andrews JR, Lawn SD, Rusu C, Wood R, Noubary F, Bender MA, et al. The cost-effectiveness of routine tuberculosis screening with Xpert MTB/RIF prior to initiation of antiretroviral therapy: a model-based analysis. AIDS. 2012;26(8):987–95. doi: 10.1097/QAD.0b013e3283522d47 22333751

55. Grimsrud AT, Cornell M, Egger M, Boulle A, Myer L. Impact of definitions of loss to follow-up (LTFU) in antiretroviral therapy program evaluation: variation in the definition can have an appreciable impact on estimated proportions of LTFU. J Clin Epidemiol. 2013;66(9):1006–13. doi: 10.1016/j.jclinepi.2013.03.013 23774112

56. Stewart RD, Wells CE, Roberts SW, Rogers VL, McElwee BS, McIntire DD, et al. Benefit of interpregnancy HIV viral load suppression on subsequent maternal and infant outcomes. Am J Obstet Gynecol. 2014;211(3):297 e1–6. doi: 10.1016/j.ajog.2014.04.020 24746998

57. Onoya D, Sineke T, Brennan AT, Long L, Fox MP. Timing of pregnancy, postpartum risk of virologic failure and loss to follow-up among HIV-positive women. AIDS. 2017;31(11):1593–602. doi: 10.1097/QAD.0000000000001517 28463877


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