Journal of acquired immune deficiency syndromes (1999) · 2026
Cost-effectiveness of safer conception strategies for HIV-discordant couples in Zimbabwe.
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Hughes Carolyn Smith, Brown Joelle, Murombedzi Caroline, Chirenda Thandiwe, Chareka Gift, Mhlanga Felix, Mateveke Bismark, Gitome Serah, Makurumure Tinei, Matubu Allen, Mgodi Nyaradzo, Rutherford George, Bukusi Elizabeth, Chirenje Zvavahera, Kahn James G
Аннотация
INTRODUCTION: Data on the cost-effectiveness of safer conception strategies are limited, particularly where HIV is endemic. We evaluated the cost-effectiveness of antiretroviral therapy with frequent viral load monitoring (ART/VL), oral pre-exposure prophylaxis (PrEP), vaginal insemination (VI), and semen washing (SW) for HIV-discordant couples in Zimbabwe.
METHODS: We used decision-analytic models to compare safer conception strategies alone and in combination, with current practice. Costs (2024 USD) were estimated using micro-costing/time-and-motion studies within a safer conception program, adjusted for public-sector prices and service intensity. HIV transmission risks to partners and infants were drawn from published literature and expressed as disability-adjusted life years (DALYs). We calculated incremental cost-effectiveness ratios (ICERs) using discounted net costs and DALYs from healthcare system (base case) and societal perspectives for a single pregnancy.
RESULTS: For couples with an HIV-positive man on ART, ART/VL was dominant (more effective and less costly than current practice) and ART/VL+PrEP was cost-effective ($4,702/DALY averted). For men not on ART, PrEP (for HIV-negative partners) was dominant, ART/VL was highly cost-effective ($502/DALY averted), and ART/VL+PrEP was cost-effective ($4,942/DALY averted). For couples with an HIV-positive woman on ART, VI was dominant, and ART/VL+VI was highly cost-effective ($815/DALY averted). For women not on ART, ART(routineVL)+VI, ART/VL, and ART/VL+VI were highly cost-effective (<$1,000/DALY averted). In models excluding frequent VL monitoring and/or VI, PrEP-containing strategies remained cost-saving or highly cost-effective. SW-containing strategies were not cost-effective. Findings were robust in sensitivity analyses.
CONCLUSIONS: ART/VL, PrEP, and VI offer economically efficient mechanisms to support safer conception in Zimbabwe and similar settings.
METHODS: We used decision-analytic models to compare safer conception strategies alone and in combination, with current practice. Costs (2024 USD) were estimated using micro-costing/time-and-motion studies within a safer conception program, adjusted for public-sector prices and service intensity. HIV transmission risks to partners and infants were drawn from published literature and expressed as disability-adjusted life years (DALYs). We calculated incremental cost-effectiveness ratios (ICERs) using discounted net costs and DALYs from healthcare system (base case) and societal perspectives for a single pregnancy.
RESULTS: For couples with an HIV-positive man on ART, ART/VL was dominant (more effective and less costly than current practice) and ART/VL+PrEP was cost-effective ($4,702/DALY averted). For men not on ART, PrEP (for HIV-negative partners) was dominant, ART/VL was highly cost-effective ($502/DALY averted), and ART/VL+PrEP was cost-effective ($4,942/DALY averted). For couples with an HIV-positive woman on ART, VI was dominant, and ART/VL+VI was highly cost-effective ($815/DALY averted). For women not on ART, ART(routineVL)+VI, ART/VL, and ART/VL+VI were highly cost-effective (<$1,000/DALY averted). In models excluding frequent VL monitoring and/or VI, PrEP-containing strategies remained cost-saving or highly cost-effective. SW-containing strategies were not cost-effective. Findings were robust in sensitivity analyses.
CONCLUSIONS: ART/VL, PrEP, and VI offer economically efficient mechanisms to support safer conception in Zimbabwe and similar settings.