Katie Doherty1, Andrea Ciaranello. 1. The Medical Practice Evaluation Center, Divisions of General Medicine bInfectious Disease, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. kdoherty6@partners.org
Abstract
PURPOSE OF REVIEW: Computer simulation models can identify key clinical, operational, and economic interventions that will be needed to achieve the elimination of new pediatric HIV infections. In this review, we summarize recent findings from model-based analyses of strategies for prevention of mother-to-child HIV transmission (MTCT). RECENT FINDINGS: In order to achieve elimination of MTCT (eMTCT), model-based studies suggest that scale-up of services will be needed in several domains: uptake of services and retention in care (the PMTCT 'cascade'), interventions to prevent HIV infections in women and reduce unintended pregnancies (the 'four-pronged approach'), efforts to support medication adherence through long periods of pregnancy and breastfeeding, and strategies to make breastfeeding safer and/or shorter. Models also project the economic resources that will be needed to achieve these goals in the most efficient ways to allocate limited resources for eMTCT. Results suggest that currently recommended PMTCT regimens (WHO Option A, Option B, and Option B+) will be cost-effective in most settings. SUMMARY: Model-based results can guide future implementation science, by highlighting areas in which additional data are needed to make informed decisions and by outlining critical interventions that will be necessary in order to eliminate new pediatric HIV infections.
PURPOSE OF REVIEW: Computer simulation models can identify key clinical, operational, and economic interventions that will be needed to achieve the elimination of new pediatric HIV infections. In this review, we summarize recent findings from model-based analyses of strategies for prevention of mother-to-child HIV transmission (MTCT). RECENT FINDINGS: In order to achieve elimination of MTCT (eMTCT), model-based studies suggest that scale-up of services will be needed in several domains: uptake of services and retention in care (the PMTCT 'cascade'), interventions to prevent HIV infections in women and reduce unintended pregnancies (the 'four-pronged approach'), efforts to support medication adherence through long periods of pregnancy and breastfeeding, and strategies to make breastfeeding safer and/or shorter. Models also project the economic resources that will be needed to achieve these goals in the most efficient ways to allocate limited resources for eMTCT. Results suggest that currently recommended PMTCT regimens (WHO Option A, Option B, and Option B+) will be cost-effective in most settings. SUMMARY: Model-based results can guide future implementation science, by highlighting areas in which additional data are needed to make informed decisions and by outlining critical interventions that will be necessary in order to eliminate new pediatric HIV infections.
Authors: Kathleen M Powis; Laura Smeaton; Anthony Ogwu; Shahin Lockman; Scott Dryden-Peterson; Erik van Widenfelt; Jean Leidner; Joseph Makhema; Max Essex; Roger L Shapiro Journal: J Acquir Immune Defic Syndr Date: 2011-02-01 Impact factor: 3.731
Authors: Nicole C Schmidt; José Roman-Pouriet; Aracelis D Fernandez; Consuelo M Beck-Sagué; José Leonardo-Guerrero; Stephen W Nicholas Journal: Int J Gynaecol Obstet Date: 2011-12-22 Impact factor: 3.561
Authors: Charles S Chasela; Michael G Hudgens; Denise J Jamieson; Dumbani Kayira; Mina C Hosseinipour; Athena P Kourtis; Francis Martinson; Gerald Tegha; Rodney J Knight; Yusuf I Ahmed; Deborah D Kamwendo; Irving F Hoffman; Sascha R Ellington; Zebrone Kacheche; Alice Soko; Jeffrey B Wiener; Susan A Fiscus; Peter Kazembe; Innocent A Mofolo; Maggie Chigwenembe; Dorothy S Sichali; Charles M van der Horst Journal: N Engl J Med Date: 2010-06-17 Impact factor: 91.245
Authors: Claire L Townsend; Mario Cortina-Borja; Catherine S Peckham; Annemiek de Ruiter; Hermione Lyall; Pat A Tookey Journal: AIDS Date: 2008-05-11 Impact factor: 4.177
Authors: Jean B Nachega; Olalekan A Uthman; Jean Anderson; Karl Peltzer; Sarah Wampold; Mark F Cotton; Edward J Mills; Yuh-Shan Ho; Jeffrey S A Stringer; James A McIntyre; Lynne M Mofenson Journal: AIDS Date: 2012-10-23 Impact factor: 4.177
Authors: Eunice Wambui Nduati; Amin Shaban Hassan; Miguel Garcia Knight; Daniel Muli Muema; Margaret Nassim Jahangir; Shalton Lwambi Mwaringa; Timothy Juma Etyang; Sarah Rowland-Jones; Britta Christina Urban; James Alexander Berkley Journal: BMC Public Health Date: 2015-10-03 Impact factor: 3.295
Authors: Nancy L Hancock; Carla J Chibwesha; Samuel Bosomprah; Jonathan Newman; Mwangelwa Mubiana-Mbewe; Elizabeth Siyama Sitali; Carolyn Bolton-Moore; Clara Mbwili-Muleya; Benjamin H Chi Journal: BMC Public Health Date: 2016-05-12 Impact factor: 3.295