Obure Carol Dayo, Gaitan-Duarte Hernando, Losada Saenz Ricardo, Gonzalez Lina, Angel-Muller Edith, Laverty Maura, Perez Freddy
Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Obstetrics and Gynecology Department, Universidad Nacional de Colombia, Bogotá, Colombia.
Sex Transm Infect. 2017 Nov;93(7):482-486. doi: 10.1136/sextrans-2016-052961. Epub 2017 May 11.
HIV and congenital syphilis are major public health burdens contributing to substantial perinatal morbidity and mortality globally. Although studies have reported on the costs and cost-effectiveness of rapid diagnostic tests (RDTs) for syphilis screening within antenatal care in a number of resource-constrained settings, empirical evidence on country-specific cost and estimates of single RDTs compared with dual RDTs for HIV and syphilis are limited.
A cluster randomised controlled study design was used to compare the incremental costs of two testing algorithms: (1) single RDTs for HIV and syphilis and (2) dual RDTs for HIV and syphilis, in 12 health facilities in Bogota and Cali, Colombia. The costs of single HIV and syphilis RDTs and dual HIV and syphilis RDTs were collected from each of the health facilities. The economic costs per woman tested for HIV and syphilis and costs per woman treated for syphilis defined as the total costs required to test and treat one woman for syphilis were estimated.
A total of 2214 women were tested in the study facilities. Cost per pregnant woman tested and cost per woman treated for syphilis were US$10.26 and US$607.99, respectively in the single RDT arm. For the dual RDTs, the cost per pregnant woman tested for HIV and syphilis and cost per woman treated for syphilis were US$15.89 and US$1859.26, respectively. Overall costs per woman tested for HIV and syphilis and cost per woman treated for syphilis were lower in Cali compared with Bogota across both intervention arms. Staff costs accounted for the largest proportion of costs while treatment costs comprised <1% of the preventive programme.
Findings show lower average costs for single RDTs compared with dual RDTs with costs sensitive to personnel costs and the scale of output at the health facilities.
NCT02454816; results.
艾滋病毒和先天性梅毒是全球围产期发病率和死亡率的主要公共卫生负担。尽管多项研究报告了在一些资源有限的环境中，快速诊断检测（RDT）用于产前护理中梅毒筛查的成本和成本效益，但关于特定国家成本以及与艾滋病毒和梅毒双重RDT相比单一RDT的估计的实证证据有限。
采用整群随机对照研究设计，比较两种检测算法的增量成本：（1）艾滋病毒和梅毒单一RDT，以及（2）艾滋病毒和梅毒双重RDT，在哥伦比亚波哥大和卡利的12个卫生设施中进行。从每个卫生设施收集单一艾滋病毒和梅毒RDT以及双重艾滋病毒和梅毒RDT的成本。估计了每位接受艾滋病毒和梅毒检测的妇女的经济成本以及每位接受梅毒治疗的妇女的成本，后者定义为检测和治疗一名妇女梅毒所需的总成本。
研究设施中共有2214名妇女接受检测。在单一RDT组中，每位接受检测的孕妇成本和每位接受梅毒治疗的妇女成本分别为10.26美元和607.99美元。对于双重RDT，每位接受艾滋病毒和梅毒检测的孕妇成本以及每位接受梅毒治疗的妇女成本分别为15.89美元和1859.26美元。在两个干预组中，卡利每位接受艾滋病毒和梅毒检测的妇女的总体成本以及每位接受梅毒治疗的妇女的成本均低于波哥大。人员成本占成本的最大比例，而治疗成本占预防计划的比例不到1%。
研究结果表明，与双重RDT相比，单一RDT的平均成本更低，成本对人员成本和卫生设施的产出规模敏感。
NCT02454816；结果
