Is justified in areas of low HIV prevalence

EDITOR—The recent papers by Postma et al and Simpson et al highlight the difficult issues in establishing a policy to test for HIV infection in antenatal clinics.1 2

Postma et al's paper examines the cost effectiveness of universal, voluntary testing of pregnant women in England in terms of healthcare costs to the NHS. Although no cut off point at which the cost for each life year gained becomes acceptable has been defined for England, a cut off point of around $50 000 is suggested in the United States They conclude that in areas of high prevalence, such as London, universal, voluntary antenatal screening of pregnant women is cost effective; how- ever, in areas of low prevalence, screening may not be justified in terms of cost effectiveness.

Screening for HIV infection in antenatal clinics fulfils most of Wilson and Junger's criteria as a good test.3 HIV infection can be asymptomatic; the tests are simple, relatively pain free, sensitive and specific; and there is …