Programmes for the prevention of mother-to-child HIV infection transmission have made progress in Yunnan Province, China, from 2006 to 2015: a cost effective and cost-benefit evaluation

摘要

BackgroundPrevention of mother-to-child transmission (PMTCT) of HIV infection became a key public health priority in China in 2002 [1]. In the fifteen years since 2002, China’s HIV PMTCT programmes have played an important role in the prevention of HIV infection nationwide. A meta-analysis has shown that the mother-to-child transmission (MTCT) rate in China declined from 12.90 to 2.29% from 2004 to 2010, demonstrating a decrease year-by-year under the PMTCT strategies [2]. In 2017, China began working towards an official certification for the elimination of HIV transmission from mother-to-child via the World Health Organization.In southwest China’s Yunnan province, the number of people living with HIV and AIDS was estimated to be 93,437 at the end of 2016 [3] (total population of 4.7 million in Yunnan Province in 2016 [4]), the highest among all provinces and municipalities. PMTCT programmes have been carried out since 2003 in Yunnan Province. With more than one decade of development and efforts, these programmes have been shown to be successful. Previous studies conducted by various cities and counties in Yunnan province have shown that the coverage rate of PMTCT programmes is nearly 100% in their own areas [5,6,7,8,9,10,11,12,13,14]. Based on report data from Yunnan Provincial Maternal and Infant Health Care Centre, the MTCT rate declined from 34.80% in 2003 to 3.13% in 2015 throughout the province.However, although the clinical and public health benefits of Yunnan’s PMTCT programmes are relatively well understood, the relationship between these benefits and their economic costs and savings has not been comprehensively studied. It is known that the economic burden of HIV infection is substantial [15]. A clear and objective assessment of the return on investment due to PMTCT programmes is an important input in the decision-making process for health planners and policymakers. Tasked with allocating limited resources, health planners and policymakers must make informed evaluations whether the further scale-up of PMTCT programmes will be a cost-effective means for averting paediatric HIV infections and whether it will make good use of prevention resources [16,17,18,19]. Therefore, we primarily aimed to evaluate PMTCT programmes province-wide at the macro level by retrospectively quantifying the return on investment about Yunnan province’s PMTCT programmes over the 10 years from 2006 to 2015. Second, we aimed to estimate the historical economic impacts of the programmes from a policymaker perspective.