Reducing HIV Transmission from Mothers to Babies
Reducing HIV Transmission from Mothers to Babies
-Andreas Kuznik
There are various ways to reduce the risk of mother-to-child transmission of HIV. The most effective way is the typical triple therapy with antiretroviral drugs. These should be taken during pregnancy and then also during breastfeeding. After breastfeeding, they could then be discontinued, which is what the World Health Organization (WHO) calls “Option B.” But once initiated, these drugs could also be continued for life, which is what the WHO calls “Option B+.” Both of these options are quite a bit more expensive than some of the traditionally used methods in Uganda, such as dual therapy with only two antiretroviral agents during pregnancy; single-dose nevirapine taken only during delivery; or doing nothing, which, sadly, is also quite common and results in the greatest risk of infection to the infant.
Our 2012 paper1 published in the Bulletin of the World Health Organization showed that the health benefits to the child through the reduced risk of HIV infection more than justify the additional cost of antiretroviral therapy. In technical terms, “Option B” is cost effective relative to any of the other methods that could be used in the context. In addition, since women in Uganda tend to have a lot of children2, it also makes economic sense to continue antiretroviral therapy for life once it is initiated; that is, “Option B+” is also cost effective. I believe ours was the first paper to show that in sub-Saharan Africa. There has since been another paper to confirm the cost effectiveness of Option B+ in Zimbabwe.
The results of our research and thus this paper suggest that triple therapy for HIV-infected pregnant women in Uganda is a good use of scarce healthcare resources and should be made available more widely.
Andreas Kuznik, PhD
Director, Global Health Economics and Outcomes Research, Pfizer Inc.
Accordia Pfizer Global Health Fellow
Accordia Professor in Residence
1 Evaluating the cost-effectiveness of combination antiretroviral therapy for the prevention of mother-to-child transmission of HIV in Uganda
Bull World Health Organ 2012; 90:595-603
2 Uganda has one of the highest fertility rates in the world at more than 6 children per woman and approximately 91,000 infants are born annually to HIV-positive women.
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