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

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...

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Autores principales: 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.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857940/
https://www.ncbi.nlm.nih.gov/pubmed/31730630
http://dx.doi.org/10.1371/journal.pone.0225104
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author 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.
author_facet 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.
author_sort Dugdale, Caitlin M.
collection PubMed
description 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.
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spelling pubmed-68579402019-12-07 Cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa 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. PLoS One Research Article 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. Public Library of Science 2019-11-15 /pmc/articles/PMC6857940/ /pubmed/31730630 http://dx.doi.org/10.1371/journal.pone.0225104 Text en © 2019 Dugdale et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
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.
Cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa
title Cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa
title_full Cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa
title_fullStr Cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa
title_full_unstemmed Cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa
title_short Cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa
title_sort cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in south africa
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857940/
https://www.ncbi.nlm.nih.gov/pubmed/31730630
http://dx.doi.org/10.1371/journal.pone.0225104
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