Ciaranello, Andrea L.Myer, LandonKelly, KathleenChristensen, SarahDaskilewicz, KristenDoherty, KatieBekker, Linda-GailHou, TaigeWood, RobinFrancke, Jordan A.Wools-Kaloustian, KaraFreedburg, Kenneth A.Walensky, Rochelle P.2016-06-172016-06-172015-03-10Ciaranello, A. L., Myer, L., Kelly, K., Christensen, S., Daskilewicz, K., Doherty, K., … Walensky, R. P. (2015). Point-of-Care CD4 Testing to Inform Selection of Antiretroviral Medications in South African Antenatal Clinics: A Cost-Effectiveness Analysis. PLoS ONE, 10(3), e0117751. http://doi.org/10.1371/journal.pone.0117751https://hdl.handle.net/1805/10018BACKGROUND: Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays. METHODS: We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99%, result-return rate: 95%, cost: $26). We modeled South African PMTCT guidelines during the study period (WHO "Option A"): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/life-year saved). RESULTS: In the base case, laboratory led to projected MTCT risks of 5.7%, undiscounted pediatric LE of 53.2 years, and undiscounted PMTCT plus pediatric lifetime costs of $1,070/infant. POC led to lower modeled MTCT risk (5.3%), greater pediatric LE (53.4 years) and lower PMTCT plus pediatric lifetime costs ($1,040/infant). Maternal outcomes following laboratory were similar to POC (LE: 21.2 years; lifetime costs: $23,860/person). Compared to laboratory, POC improved clinical outcomes and reduced healthcare costs. CONCLUSIONS: In antenatal clinics implementing Option A, the higher initial cost of a one-time POC CD4 assay will be offset by cost-savings from prevention of pediatric HIV infection.en-USPublisher PolicyAnti-HIV AgentsCD4 Lymphocyte CountHIV InfectionsInfectious Disease Transmission, VerticalPoint-of-Care SystemsZidovudineArticle