Background:  The prevention of mother-to-child transmission (MTCT) of HIV has initiated an important debate in public health. Due to a scarcity of resources in developing countries to face this problem, it is necessary to identify strategies that are not only effective but also efficient. HAART therapy is now starting to become available in developing countries as a possible way of fighting HIV/AIDS, and it is also used in MTCT prevention programs. We assessed the results of the DREAM program, which is designed, run, and managed by the Community of Sant’ Egidio, an international faith-based organization. In this program, HAART is administered to all HIV⁺ pregnant women irrespective of their virological and immunological status.

Methods:  The costs of all components included in the DREAM protocol have been calculated using the “ingredients” method. Outcomes estimated are cost for infection averted and cost for disability-adjusted life-years (DALY) saved according to UNAIDS guidelines for evaluating intervention to prevent HIV transmission. The total cohort considered was of 1862 pregnant woman who tested HIV⁺, among 6500 women who underwent voluntary counseling and testing during an antenatal visit.

Results:  Previously reported cumulative incidence rate of HIV⁺ children at 6 months from delivery was 5.3%. The refusal or lost-to-follow-up rate was 19.6%. On this basis, the efficacy of intervention was 68.53% in terms of avoided infections. The use of HAART in the MTCT prevention program has proved to be largely cost-effective, with the cost for averted infection being $518 and cost for DALY saved of $22. From the perspective of a public sector scenario, intervention costs decreased to $149 for infection averted and $6 for DALY saved due to savings on the cost of HIV⁺ children for the public sector. The results largely remain under $50, which is commonly accepted as effective for developing countries. Comparisons with other kinds of intervention and different scenarios and sensitivity analysis have been conducted.

Conclusions:  The use of HAART in MTCT prevention programs is cost-effective and recommended. It is necessary to decrease the cost of lab analysis and ART in order to scale coverage of the program. Strategies to improve adherence are also recommended to improve effectiveness.