Sabin, Lucie;
(2025)
Improving integrated antenatal screening for sexually transmitted diseases: identification of barriers and facilitators and cost-effectiveness analysis.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
The World Health Organisation (WHO) recommends integrated antenatal screening for HIV, syphilis, and hepatitis B to eliminate vertical transmission. This approach allows pregnant women to be screened for all three diseases with a single blood draw in one visit, potentially increasing uptake. However, more research is needed to determine its feasibility and acceptability. This thesis explores barriers and facilitators to integrated antenatal screening for HIV, syphilis, and hepatitis B and models its impact and cost-effectiveness in Nepal. First, I investigated barriers and facilitators to antenatal screening for HIV, syphilis or hepatitis B in Asia using a systematic literature review. Evidence for syphilis and hepatitis B was limited, but several factors, including socio-demographic factors, husband and health workers’ support and risk perception, influenced HIV antenatal screening. Second, I examined factors that influenced HIV antenatal screening by analysing the Nepal Demographic and Health Surveys 2016 and 2022. Women with higher education, later pregnancy desire, and four or more antenatal care visits were more likely to be screened for HIV, while poverty and limited knowledge of vertical transmission and prevention methods were barriers to uptake. Third, by undertaking semi-structured in-depth interviews, I explored the knowledge, attitude, and perceptions of pregnant women, their family members, health workers and healthcare decision-makers on integrated antenatal screening. Results showed screening involved many stakeholders and was influenced by various factors. Implementation issues were found regarding service delivery, health workforce and medical products. Fourth, using modelling techniques, I estimated the health impact and cost-effectiveness of integrated antenatal screening strategies. Results concluded that integrated triple screening was highly cost-effective. Improving screening for HIV, syphilis and hepatitis B in Nepal requires a multi-sectoral approach, including strengthening healthcare systems, increasing investment in prevention programs and addressing stigma. In line with WHO recommendations, findings suggest that triple-integrated screening is a promising strategy for achieving the elimination of vertical transmission.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Improving integrated antenatal screening for sexually transmitted diseases: identification of barriers and facilitators and cost-effectiveness analysis |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2025. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10215833 |
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