Spreadsheet: 04ccdaaf-8b06-41c3-a52b-189040dff6f6
Sheet: 1. About this tool

 | FROM COSTING TO PLANNING:  A TOOL TO SUPPORT THE REGIONAL INITIATIVE FOR THE ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION OF HIV AND CONGENITAL SYPHILIS IN LATIN AMERICA AND THE CARIBBEAN (CTEI)
 | Developed by National Center for Global Health and Medicine (Naoko Ishikawa, Takuro Shimbo, et [NAME].)  in collaboration with Pan American Health Organization  / World Health Organization © National Center for Global Health and Medicine, Tokyo, Japan
 | The original tool was developed by the National Center for Global Health and Medicine, Japan (NCGM), to be initially used in the context of Asia-Pacific Region as result of a collaborative work with the Asia-Pacific United Nations Task Force for the Prevention of Parents-to-Child Transmission of HIV. The tool has been adapted to the context of Latin America and the Caribbean (LAC), through a collaboration between the NCGM and the Area of Family and Community Health (FCH) in the Pan American Health Organization / World Health Organization (PAHO/WHO).
 | This tool is expected to assist in estimating the economic resources needed at national or sub-national level to achieve the goals of the Regional Initiative for the Elimination of Mother-to-child transmission of HIV and congenital syphilis in Latin America and the Caribbean (EI). This information will enable stakeholders to budget the required standard package of services that has been already identified.  The CTEI may be used as an aid to prepare proposals for donors for resource mobilization, by governments or agencies, among others. This tool will only provide estimates. Actual final costs may vary due to several circumstances such as changes in conditions of market prices in countries, in the price sources used for the calculations, or in the conditions of agreements, among others.
 | The estimated initial cost responds to the investment of resources needed to cover most of the components of the prevention of mother to child transmission of HIV and congenital syphilis in a year (or the defined time period). The resulting cost savings come from the averted cost of care and treatment of children who would become infected due to lack of intervention during their first 15 years.
 | This tool is NOT a modeling tool for calculating the transmission rate, so it should not be used for this purpose. Certain differences may be observed if compared with tools specifically designed to model transmission rates.
 | This tool consists of:
 | 1. About this tool
 | 2. Instructions to explain how to use this tool
 | 3. Costing tool to calculate and estimate the costs
 | 4. Summary table of estimated costs
 | 5. Summary graphs of main results
 | 6. Drug costs for PMTCT, detailed information on estimation of drug costs for PMTCT
 | 7. Cost for replacement feeding, detailed information on estimation of replacement feeding
 | 8. Drug costs for paediatric HIV, detailed information on estimation of drug costs for paediatric HIV
 | 9. References for development of the model for this tool
 | 10. Acronyms
 | There are several assumptions that should carefully be taken into account for a proper use of this tool. These assumptions reflect:
 | • The goals of the EI: to achieve elimination of MTCT of HIV and congenital syphilis, as defined in the concept paper of the EI. • The conditions required to achieve the EI goals:   - coverage of antenatal care and skilled attendance at birth to 95 percent or more    - coverage of routine HIV and syphilis screening of pregnant women to 95 percent or more    - coverage of adequate HIV prophylactic management and treatment of syphilis in pregnant women and HIV prophylactic management of HIV in children to 95 percent or more  • The package of required interventions and the scientific and technical specificities come from the recommendations published in the Clinical Guideline for the Elimination of Mother-to-child transmission of HIV and congenital syphilis in Latin America and the Caribbean.
 | To optimize the use of the tool, an ideal scenario has been devised (Target Scenario), considering the practice in LAC, in which all elements of the EI are implemented at their maximum extent (and so will the cost). The tool can compare the current scenario (Current Scenario with ANC data, if ANC data are available, Current Scenario without ANC data, if ANC data are not available) mid-term goal scenarios (e.g. 80% coverage) (Intermediate Scenarios 1 and 2), and ideal/goal scenario (95% coverage or 100% coverage) (Target Scenario). Without adequate or reliable ANC data, the use of the column "Current Scenario without ANC data" for the current scenario is suggested. The costing tool allows to estimate countries' current scenario by entering testing and treatment coverage data, minimizing the impact of attendance to antenatal care.
 | Prevention of new paediatric HIV infections and congenital syphilis (references 4,5, and 11)
 | 1) Pregnant women had the first antenatal visit at 14 weeks of pregnancy.
 | 2) Pregnant women were tested once for HIV during the antenatal visit. If tested positive, a confirmatory test was provided.
 | 3) HIV-infected pregnant women were assessed for CD4 counts and viral load (VL) twice during pregnancy.
 | 4) Partners of HIV-infected pregnant women were also tested for HIV.
 | 5) Antiretroviral (ARV) prophylaxis was provided based on the PAHO guidelines ‘Clinical Guideline for the Elimination of Mother-to-Child Transmission of HIV and [NAME] in Latin America and the Caribbean’.
 | 6) HIV-infected pregnant women who do not need treatment for their own health started triple ARV prophylaxis (AZT+3TC+LPV/r) from the week 14 and continued until delivery.
 | 7) HIV-infected pregnant women who were eligible for antiretroviral therapy (ART) initiated treatment from the week 14 and continued thereafter. However, costs of ART were included only for antenatal period.
 | 8) Pregnant women gave birth to a baby (birth weight >2500g) at the week 38 by caesarean section or vaginal birth.
 | 9) There was no still birth and/or neonatal death.
 | 10) Replacement feeding with 14% concentrated formula was recommended for all HIV exposed infants.
 | 11) HIV-exposed infants whose mother has received ARV prophylaxis or ART received AZT for 6 weeks.
 | 12) Exposed infants started co-trimoxazole prophylaxis at 4 weeks and continued until 18 months (i.e. for 17 months).
 | 13) Exposed infants were tested twice by virological testing and once by serological testing.
 | 14) Both mother and exposed infants received follow up until the child reaches 18 months of age.
 | 15) Pregnant women were tested twice for syphilis during antenatal period.
 | 16) Partners of syphilis seropositive women were also tested for syphilis.
 | 17) Cases of maternal syphilis were treated with benzylpenicillin 2.4million unit x 3doses.
 | 18) Infants born to seropositive mothers received benzylpenicillin G 150,000 unit x 1dose.
 | 19) Infants born to seropositive mothers received serological testing for 3 times to exclude syphilis infection.
 | 20) Partners of seropositive women were treated with benzylpenicillin 2.4million unit x 1dose.
 | Treatment for paediatric HIV infection  (references 6, 7, 8, 9, and 10)
 | 1) Risk of mother-to-child transmission of HIV was estimated as follows.        ARV prophylaxis + replacement feeding - 0.5 - 2% transmission        no-ARV prophylaxis -    15-32% transmission + breastfeeding
 | 2) HIV exposed infants whose mother did not access PMTCT services were tested for HIV at 6 weeks by virological testing. If found positive, a confirmatory test was provided and ART was initiated.
 | 3) HIV infected children were assessed for CD4 counts and viral load (VL)
 | 4) HIV infected children received co-trimoxazole prophylaxis until the age of 5.
 | 5) HIV infected children received ART up to the age of 15 based on WHO guidelines 'Antiretroviral therapy for HIV infection in infants and children: towards universal access, recommendations for a public health approach 2010 version'.
 | 6) HIV infected children received follow up together with periodical laboratory monitoring.
 | 7) There was no default or loss to follow up among children on ART.
 | 8) No children were admitted to in-patient care.
 | * References used for the development of the model are included in the sheet "References"