International Journal of STD & AIDS > Volume 19, Number 6 > Pp. 406-409

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Original research articles

Cost effectiveness of couple counselling to enhance infant HIV-1 prevention

Francis N John BSc ^* , Carey Farquhar MD MPH  , James N Kiarie MMed MPH ^*, Marjory N Kabura MBChB MPH  and Grace C John-Stewart MD PhD  

^* Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya; Department of Medicine; Department of Epidemiology, University of Washington, Seattle, WA, USA; AMREF, Nairobi, Kenya

Correspondence to: Dr Francis Njiri John, Department of Obstetrics and Gynaecology, University of Nairobi, PO Box 19676, Nairobi, Kenya Email: fnjiri{at}csrtkenya.org

Data collected in the years 2001–2003 from an antenatal clinic in Nairobi, Kenya, were used to assess the benefit of couple counselling and test it as a way of increasing the uptake of interventions in the prevention of mother-to-child transmission of HIV-1. Among 2833 women enrolled, 311 (11%) received couple pretest counselling and 2100 (74%) accepted HIV-1 testing. Among those tested 314 (15%) were HIV-1 seropositive. We incorporated these and other data from the cohort study into a spreadsheet-based model and costs associated with couple counselling were compared with individual counselling in a theoretical cohort of 10,000 women. Voluntary couple counselling and testing (VCT), although more expensive, averted a greater number of infant infections when compared with individual VCT. Cost per disability-adjusted life year was similar to that of individual VCT. Sensitivity analyses found that couple VCT was more cost-effective in scenarios with increased uptake of couple counselling and higher HIV-1 prevalence.

Key Words: cost effectiveness • couple VCT • DALY • HIV-1 prevention • mother-to-child HIV-1 transmission

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