Cost-effectiveness of malaria preventive treatment for HIV-infected pregnant women in sub-Saharan Africa
Abstract Background Malaria is a leading cause of morbidity and mortality among HIV-infected pregnant women in sub-Saharan Africa: at least 1 million pregnancies among HIV-infected women are complicated by co-infection with malaria annually, leading to increased risk of premature delivery, severe an...
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ftdoajarticles:oai:doaj.org/article:c6f74344dfa24d5ea451787945dc887e 2023-05-15T15:18:11+02:00 Cost-effectiveness of malaria preventive treatment for HIV-infected pregnant women in sub-Saharan Africa Sung Eun Choi Margaret L. Brandeau Eran Bendavid 2017-10-01T00:00:00Z https://doi.org/10.1186/s12936-017-2047-x https://doaj.org/article/c6f74344dfa24d5ea451787945dc887e EN eng BMC http://link.springer.com/article/10.1186/s12936-017-2047-x https://doaj.org/toc/1475-2875 doi:10.1186/s12936-017-2047-x 1475-2875 https://doaj.org/article/c6f74344dfa24d5ea451787945dc887e Malaria Journal, Vol 16, Iss 1, Pp 1-10 (2017) Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 article 2017 ftdoajarticles https://doi.org/10.1186/s12936-017-2047-x 2022-12-31T01:54:09Z Abstract Background Malaria is a leading cause of morbidity and mortality among HIV-infected pregnant women in sub-Saharan Africa: at least 1 million pregnancies among HIV-infected women are complicated by co-infection with malaria annually, leading to increased risk of premature delivery, severe anaemia, delivery of low birth weight infants, and maternal death. Current guidelines recommend either daily cotrimoxazole (CTX) or intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp-SP) for HIV-infected pregnant women to prevent malaria and its complications. The cost-effectiveness of CTX compared to IPTp-SP among HIV-infected pregnant women was assessed. Methods A microsimulation model of malaria and HIV among pregnant women in five malaria-endemic countries in sub-Saharan Africa was constructed. Four strategies were compared: (1) 2-dose IPTp-SP at current IPTp-SP coverage of the country (“2-IPT Low”); (2) 3-dose IPTp-SP at current coverage (“3-IPT Low”); (3) 3-dose IPTp-SP at the same coverage as antiretroviral therapy (ART) in the country (“3-IPT High”); and (4) daily CTX at ART coverage. Outcomes measured include maternal malaria, anaemia, low birth weight (LBW), and disability-adjusted life years (DALYs). Sensitivity analyses assessed the effect of adherence to CTX. Results Compared with the 2-IPT Low Strategy, women receiving CTX had 22.5% fewer LBW infants (95% CI 22.3–22.7), 13.5% fewer anaemia cases (95% CI 13.4–13.5), and 13.6% fewer maternal malaria cases (95% CI 13.6–13.7). In all simulated countries, CTX was the preferred strategy, with incremental cost-effectiveness ratios ranging from cost-saving to $3.9 per DALY averted from a societal perspective. CTX was less effective than the 3-IPT High Strategy when more than 18% of women stopped taking CTX during the pregnancy. Conclusion In malarious regions of sub-Saharan Africa, daily CTX for HIV-infected pregnant women regardless of CD4 cell count is cost-effective compared with 3-dose IPTp-SP as long as more than 82% of women adhere to ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Daly ENVELOPE(63.761,63.761,-67.513,-67.513) Malaria Journal 16 1 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
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English |
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Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
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Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 Sung Eun Choi Margaret L. Brandeau Eran Bendavid Cost-effectiveness of malaria preventive treatment for HIV-infected pregnant women in sub-Saharan Africa |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
description |
Abstract Background Malaria is a leading cause of morbidity and mortality among HIV-infected pregnant women in sub-Saharan Africa: at least 1 million pregnancies among HIV-infected women are complicated by co-infection with malaria annually, leading to increased risk of premature delivery, severe anaemia, delivery of low birth weight infants, and maternal death. Current guidelines recommend either daily cotrimoxazole (CTX) or intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp-SP) for HIV-infected pregnant women to prevent malaria and its complications. The cost-effectiveness of CTX compared to IPTp-SP among HIV-infected pregnant women was assessed. Methods A microsimulation model of malaria and HIV among pregnant women in five malaria-endemic countries in sub-Saharan Africa was constructed. Four strategies were compared: (1) 2-dose IPTp-SP at current IPTp-SP coverage of the country (“2-IPT Low”); (2) 3-dose IPTp-SP at current coverage (“3-IPT Low”); (3) 3-dose IPTp-SP at the same coverage as antiretroviral therapy (ART) in the country (“3-IPT High”); and (4) daily CTX at ART coverage. Outcomes measured include maternal malaria, anaemia, low birth weight (LBW), and disability-adjusted life years (DALYs). Sensitivity analyses assessed the effect of adherence to CTX. Results Compared with the 2-IPT Low Strategy, women receiving CTX had 22.5% fewer LBW infants (95% CI 22.3–22.7), 13.5% fewer anaemia cases (95% CI 13.4–13.5), and 13.6% fewer maternal malaria cases (95% CI 13.6–13.7). In all simulated countries, CTX was the preferred strategy, with incremental cost-effectiveness ratios ranging from cost-saving to $3.9 per DALY averted from a societal perspective. CTX was less effective than the 3-IPT High Strategy when more than 18% of women stopped taking CTX during the pregnancy. Conclusion In malarious regions of sub-Saharan Africa, daily CTX for HIV-infected pregnant women regardless of CD4 cell count is cost-effective compared with 3-dose IPTp-SP as long as more than 82% of women adhere to ... |
format |
Article in Journal/Newspaper |
author |
Sung Eun Choi Margaret L. Brandeau Eran Bendavid |
author_facet |
Sung Eun Choi Margaret L. Brandeau Eran Bendavid |
author_sort |
Sung Eun Choi |
title |
Cost-effectiveness of malaria preventive treatment for HIV-infected pregnant women in sub-Saharan Africa |
title_short |
Cost-effectiveness of malaria preventive treatment for HIV-infected pregnant women in sub-Saharan Africa |
title_full |
Cost-effectiveness of malaria preventive treatment for HIV-infected pregnant women in sub-Saharan Africa |
title_fullStr |
Cost-effectiveness of malaria preventive treatment for HIV-infected pregnant women in sub-Saharan Africa |
title_full_unstemmed |
Cost-effectiveness of malaria preventive treatment for HIV-infected pregnant women in sub-Saharan Africa |
title_sort |
cost-effectiveness of malaria preventive treatment for hiv-infected pregnant women in sub-saharan africa |
publisher |
BMC |
publishDate |
2017 |
url |
https://doi.org/10.1186/s12936-017-2047-x https://doaj.org/article/c6f74344dfa24d5ea451787945dc887e |
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ENVELOPE(63.761,63.761,-67.513,-67.513) |
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Arctic Daly |
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Arctic Daly |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Malaria Journal, Vol 16, Iss 1, Pp 1-10 (2017) |
op_relation |
http://link.springer.com/article/10.1186/s12936-017-2047-x https://doaj.org/toc/1475-2875 doi:10.1186/s12936-017-2047-x 1475-2875 https://doaj.org/article/c6f74344dfa24d5ea451787945dc887e |
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https://doi.org/10.1186/s12936-017-2047-x |
container_title |
Malaria Journal |
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16 |
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1 |
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1766348409594183680 |