Population Health Research Institute, St George's, University of London, London, SW17 ORE, UK.
Aquarius Population Health Limited, Unit 29, Tileyard Studios, Tileyard Rd, London, N7 9AH, UK.
BMC Health Serv Res. 2020 Apr 16;20(1):316. doi: 10.1186/s12913-020-5062-5.
Community-based screening may be one solution to increase testing and treatment of sexually transmitted infections in sexually active teenagers, but there are few data on the practicalities and cost of running such a service. We estimate the cost of running a 'Test n Treat' service providing rapid chlamydia (CT) and gonorrhoea (NG) testing and same day on-site CT treatment in technical colleges.
Process data from a 2016/17 cluster randomised feasibility trial were used to estimate total costs and service uptake. Pathway mapping was used to model different uptake scenarios. Participants, from six London colleges, provided self-taken genitourinary samples in the nearest toilet. Included in the study were 509 sexually active students (mean 85/college): median age 17.9 years, 49% male, 50% black ethnicity, with a baseline CT and NG prevalence of 6 and 0.5%, respectively. All participants received information about CT and NG infections at recruitment. When the Test n Treat team visited, participants were texted/emailed invitations to attend for confidential testing. Three colleges were randomly allocated the intervention, to host (non-incentivised) Test n Treat one and four months after baseline. All six colleges hosted follow-up Test n Treat seven months after baseline when students received a £10 incentive (to participate).
The mean non-incentivised daily uptake per college was 5 students (range 1 to 17), which cost £237 (range £1082 to £88) per student screened, and £4657 (range £21,281 to £1723) per CT infection detected, or £13,970 (range £63,842 to £5169) per NG infection detected. The mean incentivised daily uptake was 19 students which cost £91 per student screened, and £1408/CT infection or £7042/NG infection detected. If daily capacity for screening were achieved (49 students/day), costs including incentives would be £47 per person screened and £925/CT infection or £2774/NG infection detected.
Delivering non-incentivised Test n Treat in technical colleges is more expensive per person screened than CT and NG screening in clinics. Targeting areas with high infection rates, combined with high, incentivised uptake could make costs comparable.
ISRCTN58038795, Assigned August 2016, registered prospectively.
基于社区的筛查可能是增加性活跃青少年性传播感染检测和治疗的一种解决方案，但关于运行此类服务的实际情况和成本的数据很少。我们估计了在技术学院提供快速衣原体 (CT) 和淋病 (NG) 检测和现场 CT 治疗的“检测即治疗”服务的成本。
使用 2016/17 年一项集群随机可行性试验的过程数据来估计总费用和服务利用率。路径映射用于对不同的利用率情况进行建模。来自伦敦六所学院的参与者在最近的厕所中自行采集泌尿生殖道样本。该研究包括 509 名性活跃的学生（平均每所学院 85 名）：中位年龄 17.9 岁，49%为男性，50%为黑人，基线 CT 和 NG 患病率分别为 6%和 0.5%。所有参与者在招募时都获得了有关 CT 和 NG 感染的信息。当 Test n Treat 团队访问时，参与者会收到参加机密检测的短信/电子邮件邀请。三所学院被随机分配到干预组，在基线后一个月和四个月时举办（非激励性）Test n Treat。所有六所学院在基线后七个月（当学生获得 10 英镑奖励（参与）时）举办后续 Test n Treat。
每所学院非激励性日常利用率平均为 5 名学生（范围 1 至 17 名），每名筛查学生的成本为 237 英镑（范围为 1082 英镑至 88 英镑），每名 CT 感染检测的成本为 4657 英镑（范围为 21281 英镑至 1723 英镑），每名 NG 感染检测的成本为 13970 英镑（范围为 63842 英镑至 5169 英镑）。激励性日常利用率平均为 19 名学生，每名筛查学生的成本为 91 英镑，每名 CT 感染检测的成本为 1408 英镑或 NG 感染检测的成本为 7042 英镑。如果每天的筛查能力达到（49 名学生/天），则包括奖励在内的成本为每人筛查 47 英镑，每名 CT 感染检测的成本为 925 英镑或 NG 感染检测的成本为 2774 英镑。
在技术学院提供非激励性的 Test n Treat 比在诊所进行 CT 和 NG 筛查每人筛查的成本更高。针对感染率较高的地区，并结合高激励性的利用率，可能会使成本具有可比性。
ISRCTN58038795，2016 年 8 月分配，前瞻性注册。
