Author: Peffer, D.; Osman, N. B.; Vaz, P.
In Mozambique, the HIV prevalence among the general public is about 16-17% but 25% for children aged 0-4 years. Given the fact that the reduction in vertical transmission is more than proved, and that there is still no policy in this regard in Mozambique, it was necessary to assess whether the measures to be taken for a program of intervention would be as cost-effective and cost-beneficial as has been shown in other countries. Thus, UNICEF, in co-ordination with the Ministry of Health, decided to sponsor a study.
Purpose / Objective
The purpose of the project is to support the development of a strategy for the prevention of mother-to-child transmission of HIV/AIDS and to support the prevention of vertical transmission in Chimoio municipality. The objective of this study is to compare the costs and benefits of providing pregnant women with a complete package for the prevention of mother-to-child transmission of HIV. This package consists of: improved quality of health care before, during and after birth; counselling and voluntary tests; anti-retroviral treatment with Nevirapine (NVP); and nutritional counselling. In order to do this, the study must:
The economic model used in carrying out this study was largely derived from the model developed by Health Strategies International for UNAIDS for the economic evaluation of programmes to prevent vertical transmission of HIV. We calculated the costs, results, cost-effectiveness and cost-benefits for a hypothetical programme that could potentially cover a population comparable to the urban population of Chimoio - that is 217,156 people or 9,283 pregnant women going for their first antenatal consultation. Four versions of this program were evaluated: with and without an increase in the number of MCH staff and both possibilities with and without supplies of artificial milk.
The cost-benefit analysis compares the costs of the program (costs in improving the current levels of mother and child care and costs linked to implementing the VCT and NVP programmes) to the costs of treating children infected with HIV (monetary benefits). The perspective considered was that of the Health Ministry. It does not consider the costs and savings for households or for society in general.
Key Findings and Conclusions
Interventions with packages of this nature make it possible not only to save money but also to avoid a great deal of human suffering. For a city the size of Chimoio, this programme could have the following results: each year, 132 deaths could be avoided thanks to nevirapine and thanks to the milk substitution program.
The annual cost of the program would be US$ 62,864 without any increase in staff. To this should be added US$ 15,444 if the number of staff is increased and US$ 110,417 for a milk substitution program. The costs of treating HIV-positive children could be reduced by US$ 68,106 a year because of the reduction in the number of children infected due to nevirapine, and by US$ 4,363 due to the substitute milk program. However, this latter programme could also lead to an increase of US$ 40,456 in the costs of treating children for causes other than HIV.
There would be a net savings of US$ 5,242 if there were no additional staff and no substitute milk program. There is a net cost of US$ 10,202 with an increase in staff but no substitute milk program and a net cost of US$ 156,712 with both increased staff and a substitute milk program.
Partial results from the study are comparable to others drawn up in the region. For example, we estimate the cost of VCT at US$ 7.56 per client counselled; this cost was estimated at US$ 7.30 per mother in South Africa. The final result may be difficult to compare since there is no record of publication of similar studies.
In economic terms, it is possible to implement a programme of this kind, under our conditions, without increasing the number of staff and without milk substitution, in a city such as Chimoio.
With counselling and voluntary tests, couples may adopt measures that may also lead to a reduction in horizontal transmission of HIV. Apart from all these benefits, one also notes that better care for mothers would lead to lower maternal mortality in general and, perhaps, an increased rate of family planning.
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HIV/AIDS - MTCT
Mozambique Ministry of Health