Economic impact of routine opt-out antenatal HIV screening: A systematic review

OBJECTIVES: To evaluate the economic impact of routine testing of HIV in antenatal (ANC) settings. BACKGROUND: Many children are being infected with HIV through mother to child transmission (MTCT) of the virus. Most of these infections are preventable if the mothers’ HIV status are identified in a timely manner and appropriate interventions put in place. Routine HIV testing is widely acclaimed as a strategy for universal access to HIV testing and is being adopted by developed and developing poor income countries without recourse to the economic impact. STUDY DESIGN: A systematic review of published articles. METHODS: Extensive electronic searches for relevant journal articles published from 1998 to 2015 when countries began to implement routine ANC HI testing on their own were conducted in the following databases: Science Direct, MEDLINE, SCOPUS, JSTOR, CINAHL and PubMed with search terms as listed in box 1. Manual searches were also performed to complement the electronic identification of high quality materials. There were no geographical restrictions, but language was limited to English. RESULTS: Fifty-five articles were retrieved; however, ten were eligible and included in the review. The findings showed that many programmes involving routine HIV testing for pregnant women compared to the alternatives were cost-effective and cost saving. Data from the reviewed studies showed cost savings between $5,761.20 and $3.69 million per case of previously undiagnosed maternal HIV-positive infection prevented. Overall, cost-effectiveness was strongly associated with the prevalence rate of HIV in the various settings. CONCLUSIONS: Routine HIV testing is both cost-effective and cost saving compared to the alternatives. However, there are wide variations in the methodological approaches to the studies. Adopting standard reporting format would facilitate comparison between studies and generalizability of economic evaluations.

• Population(s)
  • Women
  • Children or Youth (less than 18 years old)
  • General HIV+ population
  • General HIV- population
  • Other
• Prevention
  • Biomedical interventions
• Testing
  • Testing
• Health Systems
  • Financial arrangements