孕产妇HIV抗体筛查最佳策略的探索

目的探索在孕产妇中开展艾滋病病毒（HIV）抗体筛查的经济学效果最佳策略。方法收集我国4个HIV相对高流行地区，预防艾滋病母婴传播干预措施的实施效果指标，作为决策树模型参数，运用决策分析，对目前我国各地实施的不筛查、孕产妇自愿选择筛查和免费筛查、知情拒绝三种孕产期HIV抗体筛查策略进行评价。结果2003—2006年，孕产妇自愿选择HIV抗体筛查比例为20％，若提供免费HIV抗体筛查，孕产妇知情拒绝筛查的比例为10％，HIV感染孕产妇自愿终止妊娠的比例为25％，实施综合干预措施母婴传播率为13．83％的条件下，模拟地区成人HIV感染率在0．05％水平时，与不开展筛查、不进行任何干预策略相比，实施相同的阳性孕产妇干预措施，孕产妇自愿选择HIV筛查策略与知情拒绝筛查策略，成本为277512．88元和1248807．94元，分别可使每10万名妊娠妇女减少子代通过母亲感染HIV 1例和5．18例，效益成本比为-0．232和0．526。结论孕产妇知情拒绝HIV抗体筛查策略成本高于自愿选择筛查策略，具有最高的服务覆盖率和效益成本比。

Decision tree analysis of screening for human immunodeficiency virus among pregnant women

Objective To find out more cost-effective screening strategy for HIV among pregnant women. Methods Of effectiveness of preventive interventions for PMTCT in 4 HIV epidemic counties in China from 2003 to 2006 were collected as parameters to be used in the decision tree. Difference among three perinatal HIV screening strategies,such as not screening,opts-in and opt out screening strategy for HIV was analyzed. Results The screening proportion in opt-in strategy was 20% and 10% of pregnant women in opt out strategy refused HIV screening while 25% of HIV infected women preferred to make termination of pregnancy and the rate of mother-tochild transmission was 13.83% with integrated prevention,the cost of opt-in strategy was 277 512.88 yuan and the cost of opt out strategy was 1 248 807.94 yuan. Opt-in and opt out strategies would prevent 1 and 5. i8 cases per 100 000 from HIV infection via MTCT,respectively,with a prevalence rate of 0.05%. The benefit-cost ratio was -- 0. 232 in the opt in strategy and 0. 526 in the opt-out strategy. Conclusion Opt-out screening strategy is the most cost-effective strategy and covers more target population.