HIV screening in pregnant women: A systematic review of cost‐effectiveness studies

Introduction Vertical transmission represents the major route of HIV infection for children. However, the preventive interventions available are extremely effective. This review summarizes evidence regarding the cost‐effectiveness of mother‐to‐child‐transmission preventive screenings, to help policy makers in choosing the optimal antenatal screening strategy. Methods A systematic review following PRISMA guidelines was conducted, using 3 databases: PubMed, Scopus, and Cost‐Effectiveness Analysis Registry. All articles regarding HIV screening to avoid vertical transmission were included. Results The review included 21 papers. Seven studies assessed the cost‐effectiveness of universal antenatal screening during early gestation. Two papers considered the integration of HIV screening with other medical interventions. Eight works estimated the cost‐effectiveness of HIV screening in late pregnancy. Finally, 4 papers considered the combination of multiple strategies. The selected papers focused on both developed and developing countries, with a different HIV prevalence. The characteristics and methodology of the studies were heterogeneous. However, all studies agreed about the main findings, outlining the cost‐effectiveness of both universal antenatal screening and HIV rescreening in late pregnancy. Cost‐effectiveness improved when HIV burden increased. The major findings were proved to be robust across various scenarios when tested in sensitivity analysis. Conclusions The review confirmed the cost‐effectiveness not only of HIV universal antenatal screening but also of rescreening in late gestation in both developed and developing countries. Universal screening is cost‐effective even in case of extremely low HIV prevalence. Therefore, to maximize screening, coverage appears as a worldwide priority. In certain settings, a targeted screening towards high‐risk groups could be a valuable option.