Background: Rwanda's National PMTCT program aims to achieve elimination of new HIV infections in children by 2015. In November 2010, Rwanda adopted the WHO 2010 ARV guidelines for PMTCT recommending Option B (HAART) for all HIV-positive pregnant women extended throughout breastfeeding and discontinued (short course-HAART) only for those not eligible for life treatment. The current study aims to assess the cost-effectiveness of this policy choice.
Methods: Based on a cohort of HIV-infected pregnant women in Rwanda, we modelled the cost-effectiveness of six regimens: dual ARV prophylaxis with either 12 months breastfeeding or replacement feeding; short course HAART (Sc-HAART) prophylaxis with either 6 months breastfeeding, 12 months breastfeeding, or 18 months breastfeeding; and Sc-HAART prophylaxis with replacement feeding. Direct costs were modelled based on all inputs in each scenario and related unit costs. Effectiveness was evaluated by measuring HIV-free survival at 18 months. Savings correspond to the lifetime costs of HIV treatment and care avoided as a result of all vertical HIV infections averted.
Results: All PMTCT scenarios considered are cost saving compared to "no intervention." Sc-HAART with 12 months breastfeeding or 6 months breastfeeding dominate all other scenarios. Sc-HAART with 12 months breastfeeding allows for more children to be alive and HIV-uninfected by 18 months than Sc-HAART with 6 months breastfeeding for an incremental cost per child alive and uninfected of 11,882 USD. This conclusion is sensitive to changes in the relative risk of mortality by 18 months for exposed HIV-uninfected children on replacement feeding from birth and those who were breastfed for only 6 months compared to those breastfeeding for 12 months or more.
Conclusion: Our findings support the earlier decision by Rwanda to adopt WHO Option B and could inform alternatives for breastfeeding duration. Local contexts and existing care delivery models should be part of national policy decisions.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577801 | PMC |
| http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054180 | PLOS |
Publication Analysis
Top Keywords
Similar Publications
Decadal trends in the exclusive breastfeeding practices among working Indian mothers: a multi-level analysis.
Int Breastfeed J
December 2024
Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda (Punjab), Bathinda, 151001, India.
Background: Exclusive breastfeeding (EBF) is defined as feeding infants only breast milk of the mother or a wet nurse for the first six months, without additional food or liquids except the oral rehydration solution or drops/syrups of vitamins, minerals or medicines. The working status of women in developed countries adversely affects the EBF rates, which calls for an assessment in rapidly developing countries like India. Therefore, the primary aim of the present study is to determine the prevalence of EBF using the data from the National Family Health Surveys (NFHS 3, 4, 5) conducted between 2005 and 06, 2015-16 and 2019-21 to estimate the likelihood EBF according to mothers' employment status.
View Article and Find Full Text PDFMobile-based peer-led theoretically-designed intervention on continued breastfeeding among Iranian mothers.
BMC Pregnancy Childbirth
December 2024
Department of Public Health, School of Public Health & Safety, Shahid Beheshti University of Medical Sciences, P.O. Box, Tehran, 19835-35511, Iran.
Background: This study addresses the determination of educational intervention-based on the Theory of Planned Behavior (TPB)-effectiveness on continued breastfeeding among Iranian mothers attending health centers, considering low researchers' attention to the continued breastfeeding index despite its important impact on children's health.
Methods: The present study was conducted among 230 mothers with exclusively breastfed infant (115 in the intervention group and 115 in the control group). Sampling starts with randomly selecting 12 health centers among all health centers in Karaj, Alborz province, and allocating them randomly into two equal groups of intervention and control.
Scurvy in an 18-month-old child mimicking a clinical presentation of rickets.
Arch Pediatr
December 2024
General Pediatric Department, Versailles hospital, Le Chesnay, France.
Scurvy is now considered to be a rare disease in European countries, even among children, but it still exists. We report the case of an 18-month-old boy who was initially hospitalized for a walking disorder and ultimately diagnosed with scurvy. Radiographs were compatible with rickets, but biological analysis ruled out this diagnosis.
View Article and Find Full Text PDFAssessment of the safety and gut microbiota modulation ability of an infant formula containing Bifidobacterium animalis ssp. lactis CP-9 or Lactobacillus salivarius AP-32 and the effects of the formula on infant growth outcomes: insights from a four-month clinical study in infants under two months old.
BMC Pediatr
December 2024
Research Product Department, R&D Center, Glac Biotech Co., Ltd, Tainan City, Taiwan.
Background: Breast milk is a natural treasure for infants, and its microbiota contains a rich array of bacterial species. When breastfeeding is not possible, infant formula with probiotics can be used as a sole source or as a breast milk supplement. The main aim of this study was to evaluate the growth outcomes and tolerance of infants consuming an infant formula containing Bifidobacterium animalis ssp.
View Article and Find Full Text PDFMaternal characteristics are associated with human milk anti-inflammatory proteins in two populations.
Sci Rep
December 2024
Department of Anthropology, University of South Florida, 4202 E. Fowler Ave. SOC107, Tampa, FL, 33620, USA.
Milk anti-inflammatory compounds are ubiquitous in milk but vary greatly within and between populations. The causes of this variation and how this variation impacts infant phenotype is not well-characterized. The goal of this study was to explain how maternal characteristics across two disparate populations impact the levels of TGF-β2 and IL-1ra in human milk.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!