News Release

UCSF Study Finds Drug Treatment Can Be Cost Effective In Tanzania And Thailand For HIV-Positive Pregnant Women

Peer-Reviewed Publication

University of California - San Francisco

Geneva, Switzerland -- Antiviral drug treatment can be a cost-effective measure in both Tanzania and Thailand to reduce the high rate of mother-to-child transmission of HIV, say University of California San Francisco AIDS researchers.

In a new study, the UCSF team found that short-course therapy using the antiviral drug zidovudine, or AZT, was economically feasible in both urban and rural populations in these countries.

Research findings were reported here today (July 3) at the 12th World AIDS Conference.

"In this study, we wanted to determine under what conditions, if any, this short-course drug regimen might be a good investment compared with funding for other types of HIV prevention efforts in very poor countries, such as Tanzania, and in those with more resources, such as Thailand," said Elliot Marseille, DrPH, MPP, lead investigator and senior research associate with the UCSF AIDS Research Institute and the UCSF Institute for Health Policy Studies.

The researchers chose AZT for their economic analysis because of previous clinical trials in Thailand that showed short-course treatment with this drug reduced transmission of HIV from pregnant women to their unborn children by 50 percent. The trials were sponsored by the Centers for Disease Control and Prevention.

"This is important because short-course therapy, which begins four weeks before the birth due date and ends after delivery, is far more affordable than the standard regimen in the industrialized world, which begins 12 weeks before the due date and also involves continued treatment of the infant in the post-natal period," Marseille said.

He added, "This means that prevention is now possible for a much higher portion of mother-to-child HIV transmission cases worldwide."

In the UCSF study, researchers used a mathematical model to calculate cost-effectiveness by comparing costs and outcomes of no drug treatment to short-course AZT therapy in pregnant women from three different settings. The settings were rural Tanzania with an HIV prevalence rate among pregnant women of 15 percent, an urban area of Thailand with a low rate of 1.8 percent, and an urban area of Thailand with a high rate of 5.2 percent. The study's key findings include:

  • The estimated net cost per case of HIV infection averted with the AZT regimen is $832 for rural Tanzania, $10,885 for urban Thailand with low HIV prevalence, and $3,163 for urban Thailand with high prevalence.
  • Cost effectiveness declines rapidly when the HIV prevalence rate is below 7 percent.
  • In Tanzania and in the high prevalence areas of Thailand, the relative costs and benefits of these drug treatments are in the same range as other HIV prevention programs, such as blood screening and condom promotion programs.
  • The drug interventions become still more economical if it is possible to reduce the costs of counseling and testing pregnant women for HIV without compromising the quality of these services.

Study co-investigators are James G. Kahn, MD, MPH, UCSF associate professor of health policy and epidemiology, who presented the findings at the Geneva meeting; and Joseph Saba, MD, clinical research specialist, United Nations AIDS Program.

Last week, Glaxo Wellcome and other pharmaceutical manufacturers announced plans to reduce prices of AIDS drugs in low-income countries to about 25 percent of industrial world prices, according to Marseille.

"This action opens the way for large-scale drug interventions because we now know that these therapies can make both medical and economic sense," he said. In previous studies in the U.S., the AIDS Clinical Trial Group of the National Institutes of Health found treatment with AZT beginning at the 28th week of pregnancy reduced mother-to-child HIV transmission by about 66 percent.

"While this protocol has great implications for efforts to stem transmission, it is not practical in most developing countries where women normally do not seek prenatal care this early in the pregnancy and a long course of therapy is too costly given their limited resources," Marseille said.

According to co-investigator Kahn, the UCSF analysis "demonstrates that the interventions initially tested in the U.S. and other wealthy countries can lead to affordable public health strategies in poorer countries." But several steps must occur, he noted, for this to happen: shorter therapy and other changes to minimize resource use, careful evaluation of treatment efficacy of modified therapies, and reduction of high cost components, such as drug prices.

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