How much paediatric HIV infection could be prevented by antenatal HIV testing?

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Maternal and Child Health

Background:

• Human Immunodeficiency Virus (HIV) infection poses a significant risk of vertical transmission from mother to child.
• Antenatal HIV testing is a crucial intervention to identify infected pregnant women and implement strategies to prevent transmission.

Purpose of the Study:

• To estimate the potential reduction in paediatric HIV infections through expanded voluntary antenatal HIV testing.
• To assess the impact of interventions on preventing vertical HIV transmission.

Main Methods:

• Data were sourced from neonatal seroprevalence studies, obstetric/paediatric reporting, and external information reviews.
• Sensitivity analyses were conducted to evaluate parameter uncertainties.
• Modeling was used to estimate the impact of testing and interventions on infection rates.

Main Results:

• Annually, an estimated 169 births in London are to undiagnosed HIV-infected women, resulting in 28-33 paediatric HIV infections.
• A testing program identifying 70% of infected women, coupled with interventions (exclusive bottle feeding, halved transmission risk), could prevent 12-16 infections (42-46%) annually.
• Precise prevention figures are limited by uncertainties in testing uptake and intervention efficacy/acceptability.

Conclusions:

• The cost of preventing paediatric HIV infections is substantial but should be weighed against lifetime care costs.
• The feasibility of selective antenatal HIV testing strategies warrants consideration in policy development.
• Auditing new antenatal HIV testing programs is recommended for accurate cost-benefit analysis.