Prevention Of Mtct Of Hiv Resource Investment And Utilization Of Research

Background:Although a mass of resources have been invested to stop the AIDS epidemic,needs of prevention and treatment for HIV/AIDS still fails to be met.Increased resources are needed to be invested into prevention of mother-to-chilc transmission(PMTCT),as the number of women affected by HIV/AIDS increase year by year,which makes PMTCT one of the most effective interventions to reduce newly HIV infections.Research on investment and utilization of PMTCT in China,economic analysis of interventions,and evidence for scientific allocation are insufficient.Objective:General objective of the study is to describe the investment of PMTCT from the role of total cost,based on current situation in China.Interventions are evaluated by cost-effectivness analysis.Influential factors of resource investment for PMTCT are investigated,and resources for PMTCT are also forecast.As a result,researches will provide scientific evidence for policy-makers to develop a cost-effective and feasible strategy to prevent MTCT.Method:Data of local resource investment for PMTCT in 4 HIV epidemic counties(Guangxi Hezhou Babu,Xinjiang Yining,Yunnan Longchuan,Yunnan Ruili)in China from 2003～2006 were collected.Data of maternal HIV screening,interventions for HIV-infected women and the infants born to HIV-infected mothers were also collected.Cost analysis and cost-effectiveness analysis were conduct.Average costs per case diagnosised HIV,average costs per case prevented and costs per DALY were calculated.Partial correlation analysis and principal components analysis were used to conduct correlative analysis for 6 experiential factors and 3 comprehensive parameters.Demand index 1 was constructed,and demand forecast model was built by multiple linear regression analysis.A decision tree was developed based on parameters collected on-site.Difference between two perinatal screening strategies for HIV was analysed,and sensitivity analysis was conducted.Result:Resource invested for prevention of mother-to-child transmission of HIV converted into RMB￥4,440,951 during 2003 to 2006 in studied areas.Investment from central government was the main source which accounted for 85.58%.A total of 7,064 health personnels were trained for PMTCT.Perinatal screening rate increased year by year(P＜0.001),and 75,797(63.75%) maternities received free HIV screening.485 women were identified to be HIV-infected,and 126 of them voluntary made terminal of pregnancy choice and the other 359 women gave birth with a total of 355 live birthes.The project provided free antiretroviral drugs for 213 (59.33%)maternities and 283(79.72%)infants exposed to HIV.It was estimated that a total of 95 children were prevented from being infected and 2,375 DALYs were saved at a 13.8% mother-to-child transmission rate.Average cost of per perinatal screening was￥36.51,and average cost of identifying one HIV-infected mother was￥5,512.03.Costs of per paediatric HIV case averted and per disability-adjusted life-year(DALY)were￥46,747 and￥1,870 (＄231),respectively,based on total cost perspective.Excess death of infants exposed to HIV in the program counteracted 19.6%retrieved DALYs.Investment for PMTCT resource increased year by year which was related positively with per capita gross domestic product(GDP)(P＜0.01).The resources invested were different in different counties(P＜0.01),which was related with local population(P＜0.01),female HIV prevalence(P＜0.l)and maternal and children's health care demand(P＜0.05).The structures of resources allocation were different in 4 study counties(P＜0.001).Cost-effectiveness of universal antinatal HIV screening in China has assumed a prevalence of HIV of＞0.036%. Opt-out screening strategy was more cost-effective than opt-in strategy.Main conclusionsPMTCT resources investment in study areas was essentially identical to the demands. Resources alloction was rationalizing,but the model of allocation was not continual.The resources were well utilized,and the program was highly efficient.The coverage of prevention services increased year by year and interventions were effective.Many of paediatric HIV cases were averted.Cost of the intervention for PMTCT was well controlled, and cost per case averted was low."Opt-out"strategy was more cost effectiveness.An important step now is to scale up PMTCT service coverage throught China.Local population, female HIV prevalence and maternal and children's health services demand has affected the investment of PMTCT.The demand of PMTCT services is of a large magnitude,but the investment is insufficient in China.The issue of HIV exposed infants' excess deathes is a major challenge of PMTCT program in China.