14th International AIDS Conference Barcelona, Spain - July 7-12, 2002

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. ThOrD1431)

de Zoysa I, Sweat M, Schmid G, O'Reilly K, Denison J
World Health Organization, Geneva, Switzerland

BACKGROUND: WHO advocates a 3-prong strategy to reduce mother to child HIV transmission: (1) preventing HIV among women, especially young women (2) preventing unintended pregnancies in HIV-infected women, and (3) preventing transmission from an HIV-infected woman to her infant. Nevirapine (NVP) has been shown to be highly effective in preventing MTC HIV transmission and has gained significant attention and donor support. The ideal balance between these approaches is being debated, but often in the absence of empirical analysis.

METHODS: Using data from demonstration projects conducted by UNICEF, and behavioral, cost, and demographic data we estimated the cost-effectiveness of NVP in African countries using a stochastic model. Multiple scenarios are calculated to examine variation in cost, uptake, and biologic parameters. Threshold analysis is used to calculate the reduction in adult HIV prevalence that would result in an equivalent reduction in infant HIV infection. Uganda results are presented here, which are illustrative of our analyses.

RESULTS: In our lowest cost scenario a nationwide NVP program would cost $5.9M (USD) per/year and avert 1404 infant HIV infections. If HIV prevalence among antenatal women could be lowered from 8.9% to only 7.9% there would be an equivalent reduction in infant HIV infections as the NVP program, but also a reduction of 93,111 adult infections.

CONCLUSIONS: Primary prevention to reduce adult HIV prevalence has significant impacts on the rate of MTC transmission of HIV, and should be a core component of PMTCT programs to prevent HIV infection in infants.

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ThOrD1431

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