ROUTINE PRENATAL SCREENING FOR HIV IN A LOW-PREVALENCE SETTING

Background: The objectives of this study were to assess the effect of British Columbia's June 1994 guidelines for prenatal HIV screening on the rate of maternal-fetal HIV transmission and to estimate the cost-e ffectiveness of such screening. Methods: The authors conducted a retro spective review of pregnancy and delivery statistics, HIV screening pr actices, laboratory testing volume, prenatal and labour management dec isions of HIV-positive women, maternal-fetal transmission rates and as sociated costs. Results: Over 1995 and 1996, 135 681 women were pregna nt and 92 645 carried to term. The rate of HIV testing increased from 55% to 76% of pregnancies on chart review at one hospital between Nove mber 1995 and November 1996. On the basis of seroprevalence studies, a n estimated 50.2 pregnancies and 34.3 (95% confidence interval 17.6 to 51.0) live births to HIV-positive women were expected. Of 42 identifi ed mother-infant pairs with an estimated date of delivery during 1995 or 1996, 25 were known only through screening. Of these 25 cases, ther e were 10 terminations, 1 spontaneous abortion and 14 cases in which t he woman elected to carry the pregnancy to term with antiretroviral th erapy. There was one stillbirth. One instance of maternal-fetal HIV tr ansmission occurred among the 13 live births. The net savings attribut able to prevented infections among babies carried to term were $165 58 6, with a saving per prevented case of $75 266. Interpretation: A rout ine offer of pregnancy screening for HIV in a low-prevalence setting r educes the rate of maternal-fetal HIV transmission and may rival other widely accepted health care expenditures in terms of cost-effectivene ss.