       Document 0424
 DOCN  M9630424
 TI    How much paediatric HIV infection could be prevented by antenatal HIV
       testing?
 DT    9603
 AU    Dunn DT; Nicoll A; Holland FJ; Davison CF; Department of Epidemiology
       and Biostatistics, Institute of Child; Health, London, United Kingdom.
 SO    J Med Screen. 1995;2(1):35-40. Unique Identifier : AIDSLINE MED/96091283
 AB    OBJECTIVE--To estimate the reduction in the number of children infected
       with HIV that might be achieved by extending the provision of voluntary
       antenatal HIV testing. This effect would be mediated by increased
       numbers of women infected with HIV who receive an intervention to reduce
       the risk of vertical transmission (for example, zidovudine or caesarean
       section delivery), who use an alternative to breast feeding, or whose
       pregnancy is terminated. SETTING--London, United Kingdom.
       METHODS--Relevant data were derived from neonatal seroprevalence
       studies, obstetric and paediatric reporting schemes, and review of
       external information. Sensitivity analyses were performed for certain
       parameters. RESULTS--Of 106,000 births annually in London, an estimated
       169 are to women infected with HIV whose infection is not currently
       recognised before pregnancy. An estimated 28-33 children born to these
       women will be infected. Precise prediction of the number of paediatric
       HIV infections that could be prevented is difficult because of
       uncertainty in certain factors, particularly the uptake of antenatal
       testing and the efficacy and acceptability of interventions to reduce
       prenatal or perinatal transmission. If a testing programme detected 70%
       of infected women, none of whom opted for a termination but all of whom
       exclusively bottle fed and received an intervention which halved the
       risk of transmission, about 12-16 (42-46%) paediatric HIV infections
       would be prevented annually. CONCLUSIONS--The estimated cost of
       preventing each paediatric infection is high, but this should be seen in
       the context of the lifetime health and social care costs for a child
       infected with HIV. The feasibility of selective testing should be
       considered when formulating policies on antenatal HIV testing.
       Programmes that are introduced should be audited to obtain better
       estimates of costs and benefits.
 DE    Bottle Feeding  Breast Feeding  Cesarean Section  Disease Transmission,
       Vertical/*PREVENTION & CONTROL  Female  Human  HIV
       Infections/DIAGNOSIS/*PREVENTION & CONTROL/TRANSMISSION  *HIV
       Seroprevalence  Infant, Newborn  London/EPIDEMIOLOGY  Mass Screening
       *Models, Statistical  Pregnancy  *Pregnancy Complications, Infectious
       Prenatal Care  Probability  Risk Factors  Support, Non-U.S. Gov't
       Zidovudine/THERAPEUTIC USE  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

