{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T23:40:50Z","timestamp":1787701250001,"version":"build-2784847793"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R37 HD079214"],"award-info":[{"award-number":["R37 HD079214"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01 HD079214-10S1"],"award-info":[{"award-number":["R01 HD079214-10S1"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["K08 HD101342"],"award-info":[{"award-number":["K08 HD101342"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01 HD111355"],"award-info":[{"award-number":["R01 HD111355"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Disease","doi-asserted-by":"publisher","award":["K24 AI131928"],"award-info":[{"award-number":["K24 AI131928"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Disease","doi-asserted-by":"publisher","award":["UM1 AI069424"],"award-info":[{"award-number":["UM1 AI069424"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Disease","doi-asserted-by":"publisher","award":["UM1 AI068636"],"award-info":[{"award-number":["UM1 AI068636"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Long-acting antiretroviral therapy (LA-ART) may reduce adherence barriers for postpartum women with HIV (PPWH), reducing vertical transmission (VT) and improving pediatric life expectancy (pLE), but efficacy and drug costs are uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a microsimulation model, we simulated mother-infant dyads for two cohorts of PPWH engaged in care, receiving oral tenofovir\/lamivudine\/dolutegravir (TLD) in pregnancy, and facing adherence challenges in Zimbabwe: mothers without (NVS) and with (VS) viral suppression at delivery. We modeled two post-delivery strategies: standard of care (SOC: TLD continuation) or LA-ART (switching to LA-cabotegravir\/rilpivirine [CAB\/RPV]). Key inputs included: 6-month-postpartum viral suppression (LA-ART: NVS = 85%\/VS = 90%; SOC: NVS = 63%\/VS = 78%), ART costs\/year (CAB\/RPV=$144\/TLD=$43.20), and VT risk (0.06%\u20130.89%\/month, range by maternal RNA). Outcomes include VT, pLE, costs (maternal ART in breastfeeding plus pediatric HIV-related lifetime care), and incremental cost-effectiveness ratios (ICERs, $\/year-of-life-saved [YLS]; cost-effective: ICER\u2264$800\/YLS [0.5\u00d7 Zimbabwe GDP].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>LA-ART would reduce VT compared with SOC (NVS: from 7.49% to 6.58%\/VS: from 4.17% to 3.80%), averting \u223c160 infections\/year in Zimbabwe. For NVS, LA-ART would improve pLE (SOC = 66.08y, LA-ART = 66.40y) at nearly equal cost (SOC = $764\/child, LA-ART = $763\/child); LA-ART would not be cost-effective if CAB\/RPV cost &amp;gt;$228\/year or 6-month suppression were &amp;lt;74%. For VS, LA-ART would lead to higher pLE and costs (67.52y, $555\/child) than SOC (67.40y, $445\/child), with ICER=$2449\/YLS; LA-ART would become cost-effective if CAB\/RPV cost \u2264$84\/year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LA-ART for breastfeeding women experiencing adherence challenges could reduce infant infections. If efficacies and costs are confirmed, LA-ART for NVS women would improve outcomes and be minimally cost-saving; for VS women, LA-ART would be cost-effective in Zimbabwe at costs \u2264$84\/year.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiaf521","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T13:08:56Z","timestamp":1763125736000},"page":"e192-e202","source":"Crossref","is-referenced-by-count":2,"title":["Long-Acting Antiretroviral Therapy for Breastfeeding Women With HIV Experiencing Barriers to Adherence in Zimbabwe: Modeling Clinical Impact and Cost-effectiveness"],"prefix":"10.1093","volume":"233","author":[{"given":"Sujata E","family":"Tewari","sequence":"first","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risa","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at the University of California , Los Angeles, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5384-9716","authenticated-orcid":false,"given":"Shahin","family":"Lockman","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital , Boston, Massachusetts ,","place":["USA"]},{"name":"Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health , Boston, Massachusetts ,","place":["USA"]},{"name":"Botswana Harvard Health Partnership , Gaborone ,","place":["Botswana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2425-7690","authenticated-orcid":false,"given":"Clare F","family":"Flanagan","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4015-2581","authenticated-orcid":false,"given":"Karen A","family":"Webb","sequence":"additional","affiliation":[{"name":"Organization for Public Health Interventions and Development , Harare ,","place":["Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1135-0262","authenticated-orcid":false,"given":"Stephanie","family":"Horsfall","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anesu","family":"Chimwaza","sequence":"additional","affiliation":[{"name":"Zimbabwe Ministry of Health and Child Care , Harare ,","place":["Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6604-6111","authenticated-orcid":false,"given":"Caitlin M","family":"Dugdale","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]},{"name":"Harvard Medical School , Boston, Massachusetts ,","place":["USA"]},{"name":"Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts 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Boston, Massachusetts ,","place":["USA"]},{"name":"Harvard Medical School , Boston, Massachusetts ,","place":["USA"]},{"name":"Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]},{"name":"Harvard University Center for AIDS Research , Cambridge, Massachusetts ,","place":["USA"]},{"name":"Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1587-6403","authenticated-orcid":false,"given":"Kenneth","family":"Masiye","sequence":"additional","affiliation":[{"name":"Organization for Public Health Interventions and Development , Harare ,","place":["Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1963-528X","authenticated-orcid":false,"given":"Aadia","family":"Rana","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Alabama at the Birmingham Heersink School of Medicine , Birmingham, Alabama ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Mushavi","sequence":"additional","affiliation":[{"name":"Zimbabwe Ministry of Health and Child Care , Harare ,","place":["Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Ebem","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kudakwashe 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