Interventions to reduce mother-to-child transmission in South Africa
Kinghorn, A.
Aids Analysis Africa 8(5): 10-11
1998
ISSN/ISBN: 1016-8974 PMID: 12294315 Document Number: 278304
An estimated 120,000 pregnant women in South Africa will be HIV-infected in 1998 and about one-third of their infants will acquire HIV. Several studies have confirmed the efficacy of zidovudine (AZT) treatment initiated as late as the 36th week of pregnancy in reducing maternal-fetal HIV transmission. Moreover, drug manufacturers have announced that AZT will be made available to developing countries at a 50% or greater discount. Implementation of this strategy in South Africa has been impeded by concerns as to whether AZT treatment is cost-effective or feasible given public sector constraints. An analysis of the costs of a universally accessible vertical transmission prevention program (pre- and post-test counseling for all pregnant women, HIV testing, AZT from the 36th week of pregnancy, and 6 months of formula for infants of HIV-positive mothers) suggests such a program would consume 0.4% of South Africa's health budget in 1998 and 0.7% by 2005. The cost per disability adjusted life year gained ranged US$26-65, which compares favorably to other generally accepted health interventions. Actual costs would depend on the program's rate of implementation, coverage, and efficiency as well as final prices for AZT and HIV testing. Budgetary problems would be more severe in provinces with the most advanced HIV epidemics. Pilot projects are important both to validate assumptions about AZT's cost-effectiveness and establish capacity for wider implementation.