Screening women of childbearing age for human immunodeficiency virus: A model-based policy analysis

This paper analyzes the costs and benefits of screening women of childbearing age for HIV. The analysis is based on a dynamic compartmental model of the HIV epidemic that incorporates disease transmission and progression over time, behavioral changes, and effects of screening and associated counseling and education. The model allows one to consider not only effects on the screened women and their newborns, but also effects on the rest of the population. The analysis reveals that the primary benefit of screening programs targeted to women of childbearing age lies not in the prevention of HIV infection in their newborns but in the prevention of infection in their adult contacts. We find that screening medium and high risk women is likely to be cost-beneficial. Screening women regardless of risk group may also be cost-beneficial if screened positive women show relatively modest levels of behavioural change, but screening programs that reach primarily low risk women are not likely to be cost-beneficial. The results hold over a broad range of sensitivity analyses of important variables.