Table 3 Cost-effectiveness analysis of HIV early infant diagnosis results of included studies

NAT at 6 weeks only

No EID testing strategy

1250/YLS

South Africa

2013 USD

50% of GDP (3416). Also examined thresholds of 100% and 300% of GDP

Yes

Francke et al. [24]

NAT at birth + 6 weeks

NAT at 6 weeks only

2900/YLS

PoC EID

SoC: conventional laboratory-based EID

680/YLS

Zimbabwe

2016 USD

1 × GDP (1010)

Yes

Frank et al. [52]

PoC EID (GeneXpert Gel)

SoC: conventional laboratory-based EID

830/YLS

Zimbabwe

2017 USD

1. 1 × GDP (1600/YLS)

2. 1 × lifetime ART regimen (580/YLS)

1. Yes

McCann et al. [51]

Strengthened laboratory-based EID

Dominated

2. No

PoC testing (mPIMA)

SoC: conventional laboratory-based testing (COBAS AmpliPrep®/TaqMan®)

1554/additional infant on ART within 60 days

5976/death averted

Zambia

2018 USD

Not listed

Yes

De Broucker et al. [53]

PoC testing (GeneXpert)

23/additional infant on ART within 60 days

90/death averted

PoC testing (mPIMA)

SoC: Centralized testing

sub-Saharan Africa

2018 USD

Not listed

Yes

Salvatore et al. [50]

1. Low PMTCT setting

1. 1475/death averted

2. High PMTCT setting

2. 3888/death averted

PoC testing (GeneXpert)

1. Low PMTCT setting

1. 1297/death averted

2. High PMTCT setting

2. 3426/death averted

PoC testing (GeneXpert Edge)

1. Low PMTCT setting

1. 591/death averted

2. High PMTCT setting

2. 1527/death averted

PoC testing (mPIMA) + central testing

1. Low PMTCT setting

1. 1507/death averted

2. High PMTCT setting

2. 3963/death averted

PoC testing (GeneXpert) + central testing

1. Low PMTCT setting

1. 1357/death averted

2. High PMTCT setting

2. 3574/death averted

PoC testing (GeneXpert Edge) + central testing

1. Low PMTCT setting

1. 618/death averted

2. High PMTCT setting

2. 1593/death averted

Testing at 6 weeks, with confirmatory testing

Testing at 6 weeks, without confirmatory testing

Cost-saving

South Africa

2013 USD

Not Listed

Yes

Dunning et al. [54]

Initial rapid HIV testing to screen-out HIV-uninfected infants before DNA-rtPCR

DNA-rtPCR with Roche Amplicor v1.5

1489/infant correctly diagnosed and informed of result

Uganda

2007 USD

Not listed

Yes

Menzies et al. [41]

Universal HIV exposure screening at infant immunization visits with referral to EID

SoC: 6-week NAT for infants with known HIV exposure

1. 1340/YLS

1. Cote d'Ivoire

2018 USD

1 × GDP (1720/6380/2150, respectively)

Yes

Dunning et al. [57]

2. 650/YLS

2. South Africa

3. 670/YLS

3. Zimbabwe

Centralized EID with deferred ART based on immune/clinical criteria

Clinical/serology-based diagnosis and deferred ART

5149/LYG

Thailand

2011 USD

1 × GDP (4420)

No

Collins et al. [38]

Centralized EID with immediate ART

2615/LYG

Yes

Quality assurance system (QAS)

No quality assurance system, misdiagnosis rate 5%

1. Kenya: cost-saving

1. Kenya

2016 USD

1. Kenya: 316,559

Yes

Terris-Prestholt et al. [43]

2. South Africa: cost-saving

2. Senegal

2. South Africa: 353,251

3. Senegal: 107

3. South Africa

3. Senegal: 3949

4. Uganda: cost-saving

4. Uganda

4. Uganda: 702,078

5. Zimbabwe: cost-saving

5. Zimbabwe

5. Zimbabwe: 656,845