, Johanne Sundby
, Per Hjortdahl
, Fatrima Hussein
, Tore W. Steen
, Manonmany Velauthapillai
and Ivar Sønbø Kristiansen
Maria Romoen: Faculty of Medicine, Postal: University of Oslo, Box 1130 Blindern, N-0318 Oslo, Norway
Johanne Sundby: Faculty of Medicine, Postal: University of Oslo, Box 1130 Blindern, N-0318 Oslo, Norway
Per Hjortdahl: Faculty of Medicine, Postal: University of Oslo, Box 1130 Blindern, N-0318 Oslo, Norway
Fatrima Hussein: Ministry of Health, Postal: Gaborone, Botswana
Tore W. Steen: Ministry of Health, Postal: Gaborone, Botswana
Manonmany Velauthapillai: Ministry of Health, Postal: Gaborone, Botswana
Ivar Sønbø Kristiansen: Institute of Health Management and Health Economics, Postal: P.O. Box 1089 Blindern, NO-0317 Oslo, Norway
Abstract: Objectives: Chlamydia is the most common bacterial sexually transmitted infection worldwide and a major cause of morbidity – particularly among women and neonates. We compared costs and health consequences of using point-of-care (POC) tests with current syndromic management among antenatal care attendees in sub-Saharan Africa. We also compared erythromycin with azithromycin treatment and universal with age-based chlamydia management. Methods: A decision analytic model was developed to compare diagnostic and treatment strategies, using Botswana as a case. Model input was based upon 1) a study of pregnant women in Botswana, 2) literature reviews and 3) expert opinion. We expressed the study outcome in terms of costs (US$), cases cured, magnitude of overtreatment and successful partner treatment. Results: Azithromycin was less costly and more effective than was erythromycin. Compared to syndromic management, testing all attendees on their first visit with a 75% sensitive POC test increased the number of cases cured from 1 500 to 3 500 in a population of 100 000 women, at a cost of US$38 per additional case cured. This cost was lower in high-prevalence populations or if testing was restricted to teenagers. The specific POC tests provided the advantage of substantial reductions in overtreatment with antibiotics and improved partner management. Conclusions: Using POC tests to diagnose chlamydia during antenatal care in sub-Saharan Africa entails greater health benefits than syndromic management does – and at acceptable costs – especially when restricted to younger women. Changes in diagnostic strategy and treatment regimens may improve people’s health and even reduce health care budgets.
Keywords: Chlamydia trachomatis (MeSH); Cost-effectiveness analysis (non-MeSH); Cost Analysis (MeSH); Developing countries (MeSH); Africa (MeSH); Sub-Saharan Africa (MeSH) Maternal health (non-MeSH); Maternal Health Services (MeSH); Women’s Health (MeSH); Point-of-care tests (non-MeSH); Diagnostic tests (non-MeSH); Diagnosis (MeSH); Syndromic approach (non-MeSH); STI management (non-MeSH)
103 pages, June 3, 2009
Full text files
Questions (including download problems) about the papers in this series should be directed to Kristi Brinkmann Lenander ()
Report other problems with accessing this service to Sune Karlsson ().
This page generated on 2020-02-16 18:57:30.