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

Introduction: Verticaltransmission representsthe 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,using3databases:PubMed,Scopus,andCost‐Effectiveness AnalysisRegistry.All articles regardingHIVscreeningtoavoidvertical transmission were included. Results: Thereviewincluded21papers.Sevenstudiesassessedthe 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 costeffectiveness 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. Themajorfindingswereprovedtoberobustacrossvariousscenarios 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