Voluntary screening program for HIV in pregnancy. Cost effectiveness.

Objective: To determine the effectiveness of a voluntary human immunodeficiency virus (HIV) screening program in pregnancy.

Study Design: Using a business decision theory analysis model, we estimated the outcomes and costs of the two possible decisions by our patients (test/no test). Patients with a positive HIV screen would undergo evaluation and possible prophylactic antiviral therapy. The model was utilized to evaluate the Naval Medical Center San Diego Program from 1995-1997.

Results: Prevalence of HIV in active duty Navy personnel during the years evaluated were 1995, 0.024%; 1996, 0.028%; and 1997, 0.022%. Patients screened for HIV during these years were 1995, 3,874; 1996, 3,924; and 1997, 4,127 (n = 11,925). Incidence of HIV seroprevalence in patients screened during the study period was zero. The number of patients declining HIV screening was: 1995, 10; 1996, 8; and 1997, 5. During the same period, reported HIV seroprevalence among pregnant patients in the United States was 1.5/1,000.

Conclusion: HIV seroprevalence in our pregnant population (zero) was lower than expected, considering the national pregnancy prevalence and Navy prevalence. The expected number of cases of positive HIV screens was 17.8. The cost of the program for the study period was $103,748. The cost of care for one positive neonate ranges between $100,000 and $200,000.