Intended for healthcare professionals


Prevention of vertical transmission of HIV in South Africa

BMJ 1999; 319 doi: (Published 27 November 1999) Cite this as: BMJ 1999;319:1431

Findings probably do not apply to rest of sub-Saharan Africa

  1. Christian Gunneberg, Save the Children Fund UK, health adviser
  1. Salima, Malawi
  2. The Africa Centre, PO Box 198 Mtubatuba 3935, South Africa
  3. Division of Community Paediatrics, Department of Paediatrics, University of the Witwatersrand, PO Box 1038, Johannesburg 2000, South Africa
  4. Centre for Health Policy, University of the Witwatersrand

    EDITOR—Söderlund et al report the cost effectiveness of options available in South Africa to prevent the vertical transmission of HIV.1 I have concerns about the applicability of their findings (from an urban South African hospital setting) to the rest of sub-Saharan Africa.1 The paper's conclusion that the treatment is cost effective assumes that each child in whom seroconversion is prevented would otherwise have consumed substantial hospital resources.

    From the figures in the paper, I calculate that at least £0.33-1.73 ($0.50-2.60) per capita is spent just on HIV positive children aged under 1 in an average sub-Saharan country. This clearly does not apply to a country like Malawi, whose health expenditure is around £2.70 ($4) per capita. This cost-benefit conclusion is not applicable to most of sub-Saharan Africa, where children with HIV infection are generally treated at home and at health centres Altogether 70-80% of public health costs in most health systems are staff costs and the salaries of health workers; thus even in South Africa the postulated hospital health cost savings in the analysis could not be recovered to fund the additional drug costs.

    Using the authors' figures, I calculate that the antiretroviral drugs alone (£59 ($89) (PETRA regimen) to £267 ($400) (ACTGO76 regimen) per person treated) would cost an average …

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