Optimizing HIV retesting during pregnancy and postpartum in four countries: a cost-effectiveness analysis

Area of Science:

• Public Health
• Epidemiology
• Health Economics

Background:

• HIV retesting during pregnancy and breastfeeding can prevent mother-to-child HIV transmission (MTCT).
• Optimal timing and cost-effectiveness of maternal HIV retesting strategies remain unclear.

Purpose of the Study:

• To assess the health and economic impact of maternal HIV retesting strategies.
• To determine the most cost-effective timing for maternal HIV retesting to prevent MTCT in diverse settings.

Main Methods:

• Deterministic modeling was used to evaluate six retesting scenarios in South Africa, Kenya, Colombia, and Ukraine.
• Strategies varied in retesting frequency from late antenatal care (ANC) through nine months postpartum.
• Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs) against country-specific thresholds over a 20-year horizon.

Main Results:

• One retest in late ANC with catch-up testing up to six weeks postpartum was cost-effective in Kenya and South Africa, preventing 19% and 12% of infant HIV infections, respectively.
• Additional postpartum retests offered marginal benefits in high-burden settings but significantly increased costs.
• All retesting strategies exceeded cost-effectiveness thresholds in low-burden settings (Colombia, Ukraine), preventing minimal infant infections.

Conclusions:

• In high HIV burden settings, a single maternal HIV retest in late ANC is the most cost-effective strategy to prevent infant infections.
• Two postpartum retests offer marginal MTCT reduction at a lower cost than three retests.
• Maternal HIV retesting is not cost-effective in low HIV burden settings with low MTCT rates.