Antenatal HIV testing in the UK

Writing in the British Medical Journal, a research group from London have estimated the cost effectiveness of a universal, voluntary HIV screening programme for all pregnant women in the UK. Effectiveness was measured in terms of life years gained among children whose HIV infection would be avoided, and in life years which would be gained by mothers through the use of anti-HIV treatments. Costs analysed included those for HIV antibody testing, pre- and post-test counselling, anti-HIV treatment, elective caesarean section, and formula feed.

The lifetime costs of care for a child infected with HIV were estimated at £178,300. Hence in high prevalence areas such as London, a programme of universal, voluntary HIV screening was estimated to be cost effective, with a net cost of £4,000 for each life year gained. In lower prevalence areas, this figure might be less than £20,000, depending on the number of women unaware of their status, and the local costs of screening.

The authors base their analysis on a series of assumptions, some of which may no longer be appropriate. For example, a transmission rate of 6% was assumed for women treated with a standard antenatal course of AZT who also delivered by elective caesarean section. Recent research suggests this rate may be closer to 1%. Similarly, modern anti-HIV regimens tend to involve combinations of drugs which, though more costly than the use of AZT alone, are envisaged as more effective in preventing transmission.

In a second study featured in the same issue of the BMJ, a research team from Scotland report that the implementation of a routine, voluntary antenatal HIV screening programme more than doubled the uptake of the HIV test by pregnant women, compared with an earlier opt-in scheme. Of 924 women who attended antenatal clinics in Glasgow and Edinburgh between February and April 1998, 88% had an HIV test. Tests were offered routinely by midwives trained to discuss the benefits of testing, and to offer women the opportunity to decline. The authors conclude that a similar programme may be appropriate in other high prevalence areas of the UK, but exclude London, "where there are more complex issues of language and cultural heterogeneity".