Presentation (CTI)

OBJECTIVES: The WHO advocates for early, accessible antenatal care (ANC) testing across Africa as part of the triple elimination initiative which aims to eliminate mother-to-child transmission of HIV, syphilis and hepatitis B by 2030. Rwanda currently tests pregnant women for all three diseases using separated top-quality tests for HIV and hepatitis, but operational inefficiencies prevent testing for all three diseases in all women. Therefore, the bundled determine ANC panel could enhance testing uptake and improve maternal and neonatal outcomes, although its cost-effectiveness remains uncertain.
METHODS: An economic model assessed the cost-effectiveness of a bundled ANC panel versus conventional testing in Rwanda. A decision tree with a societal perspective and 10‑year horizon was used. Local data informed costs, resource use, and mortality; published sources were used where gaps existed. Testing protocols were based on clinician input, and epidemiological data came from UN sources. Outcomes included staff time, infections detected, vertical transmission, and perinatal deaths, measured in QALYs and DALYs, with costs reported in USD.
RESULTS: The bundled ANC panel is projected to substantively improve testing and same visit diagnosis across all three diseases with 3,132 additional maternal infections being identified which was associated with reductions of 1,075 vertical transmissions and 89 foetal deaths equating to 1,224 DALYs averted and 1,082 QALYs gained. The ANC panel is projected to reduce total health system costs by approximately $1.25 million compared to current testing practice, driven by improved efficiencies and lowered downstream treatment costs.
CONCLUSIONS: Integrated antenatal screening presents a clear cost saving opportunity to close existing gaps in maternal infection detection and prevention. The projected gains in case detection and reductions in vertical transmission and overall costs highlight the dual clinical and economic value of the bundled ANC panel.