Is HIV testing in antenatal clinics worthwhile? Can we afford it?

Area of Science:

• Public Health
• Infectious Disease Prevention
• Healthcare Management

Background:

• 0.2-0.4% of pregnant women at St Thomas's Hospital ANC are HIV positive.
• Department of Health (DH) recommends universal voluntary HIV testing in antenatal clinics (ANC) in high-prevalence areas.
• Inner London Teaching Hospital and shared care General Practice settings were examined.

Purpose of the Study:

• To examine the implications of the DH's universal voluntary HIV testing initiative in ANC.
• To assess the costs associated with implementing the DH's HIV testing recommendations.
• To identify factors influencing program costs and potential cost-saving measures.

Main Methods:

• Cost analysis of the DH's HIV testing program in an Inner London Teaching Hospital and a General Practice.
• Estimation of resource requirements, including staff and specialized counseling.
• Evaluation of factors contributing to program costs, such as informed consent and patient demographics.

Main Results:

• The program cost was estimated at £148,300 to £193,900, 2.7-3.5 times higher than DH estimates.
• Informed consent accounted for 80% of the total program cost.
• An estimated 25% of women require specialized counseling, influenced by ethnicity and risk factors.

Conclusions:

• The DH's costings underestimated program expenses, primarily due to overlooking staff requirements for informed consent.
• Significant resources are necessary for universal voluntary HIV testing in ANC, particularly for obtaining informed consent.
• Continued central direction and funding from the DH are crucial for the success of this public health initiative.