{"doi":"10.1002/jia2.25651","title":"Optimizing infant HIV diagnosis with additional screening at immunization clinics in three sub‐Saharan African settings: a cost‐effectiveness analysis","abstract":"INTRODUCTION: Uptake of early infant HIV diagnosis (EID) varies widely across sub-Saharan African settings. We evaluated the potential clinical impact and cost-effectiveness of universal maternal HIV screening at infant immunization visits, with referral to EID and maternal antiretroviral therapy (ART) initiation. METHODS: Using the CEPAC-Pediatric model, we compared two strategies for infants born in 2017 in Côte d'Ivoire (CI), South Africa (SA), and Zimbabwe: (1) existing EID programmes offering six-week nucleic acid testing (NAT) for infants with known HIV exposure (EID), and (2) EID plus universal maternal HIV screening at six-week infant immunization visits, leading to referral for infant NAT and maternal ART initiation (screen-and-test). Model inputs included published Ivoirian/South African/Zimbabwean data: maternal HIV prevalence (4.8/30.8/16.1%), current uptake of EID (40/95/65%) and six-week immunization attendance (99/74/94%). Referral rates for infant NAT and maternal ART initiation after screen-and-test were 80%. Costs included NAT ($24/infant), maternal screening ($10/mother-infant pair), ART ($5 to 31/month) and HIV care ($15 to 190/month). Model outcomes included mother-to-child transmission of HIV (MTCT) among HIV-exposed infants, and life expectancy (LE) and mean lifetime per-person costs for children with HIV (CWH) and all children born in 2017. We calculated incremental cost-effectiveness ratios (ICERs) using discounted (3%/year) lifetime costs and LE for all children. We considered two cost-effectiveness thresholds in each country: (1) the per-capita GDP ($1720/6380/2150) per year-of-life saved (YLS), and (2) the CEPAC-generated ICER of offering 2 versus 1 lifetime ART regimens (e.g. offering second-line ART; $520/500/580/YLS). RESULTS: With EID, projected six-week MTCT was 9.3% (CI), 4.2% (SA) and 5.2% (Zimbabwe). Screen-and-test decreased total MTCT by 0.2% to 0.5%, improved LE by 2.0 to 3.5 years for CWH and 0.03 to 0.07 years for all children, and increased discounted costs by $17 to 22/child (all children). The ICER of screen-and-test compared to EID was $1340/YLS (CI), $650/YLS (SA) and $670/YLS (Zimbabwe), below the per-capita GDP but above the ICER of 2 versus 1 lifetime ART regimens in all countries. CONCLUSIONS: Universal maternal HIV screening at immunization visits with referral to EID and maternal ART initiation may reduce MTCT, improve paediatric LE, and be of comparable value to current HIV-related interventions in high maternal HIV prevalence settings like SA and Zimbabwe.","journal":"Journal of the International AIDS Society","year":2021,"id":198174,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":10,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9137,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":441607,"name":"Aditya R Gandhi","orcid":"0000-0002-2095-9767","position":1,"is_corresponding":false},{"id":295672,"name":"Martina Penazzato","orcid":"0000-0001-5485-8692","position":2,"is_corresponding":false},{"id":772814,"name":"Djøra I. Soeteman","orcid":"0000-0001-8743-2604","position":3,"is_corresponding":false},{"id":647504,"name":"Paul Revill","orcid":"0000-0001-8632-0600","position":4,"is_corresponding":false},{"id":771306,"name":"Simone C. Frank","orcid":"0000-0002-0048-0150","position":5,"is_corresponding":false},{"id":369297,"name":"Andrew Phillips","orcid":"0000-0003-2384-4807","position":6,"is_corresponding":false},{"id":437796,"name":"Caitlin M. Dugdale","orcid":"0000-0002-6604-6111","position":7,"is_corresponding":false},{"id":24184,"name":"Elaine J. Abrams","orcid":"0000-0001-7938-8981","position":8,"is_corresponding":false},{"id":276220,"name":"Milton C. Weinstein","orcid":null,"position":9,"is_corresponding":false},{"id":24191,"name":"Marie‐Louise Newell","orcid":"0000-0002-1074-7699","position":10,"is_corresponding":false},{"id":361256,"name":"Intira Jeannie Collins","orcid":"0000-0003-2132-6037","position":11,"is_corresponding":false},{"id":517759,"name":"Meg Doherty","orcid":"0000-0003-2986-7129","position":12,"is_corresponding":false},{"id":772815,"name":"Lara Vojnov","orcid":"0000-0003-0488-1012","position":13,"is_corresponding":false},{"id":773295,"name":"Patricia Fassinou Ekouévi","orcid":null,"position":14,"is_corresponding":false},{"id":295671,"name":"Landon Myer","orcid":"0000-0002-8106-7658","position":15,"is_corresponding":false},{"id":361438,"name":"Angela Mushavi","orcid":"0000-0001-9588-6112","position":16,"is_corresponding":false},{"id":404352,"name":"Kenneth A. Freedberg","orcid":"0000-0003-3143-7822","position":17,"is_corresponding":false},{"id":273593,"name":"Andrea Ciaranello","orcid":"0000-0002-4268-3263","position":18,"is_corresponding":false},{"id":772813,"name":"L. H. DUNNING","orcid":"0000-0002-0098-2572","position":0,"is_corresponding":true}],"reference_count":80,"raw_metadata":null,"created_at":"2026-07-18T23:50:27.616568Z","pmid":"33474817","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}