Costs and health consequences of chlamydia management strategies among pregnant women in sub-Saharan Africa

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 agebased chlamydia management. Methods: A decision analytical 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 erythromycin. Compared with syndromic management, testing all attendees on their first visit with a 75% sensitive POC test increased the number of cases cured from 1500 to 3500 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 healthcare budgets.

Evaluation of syndromic management guidelines for treatment of sexually transmitted infections in South African women

“…This is essential as unnecessary use of antibiotics could eventually lead to a decrease in antimicrobial susceptibility of these STI (and possibly other infectious diseases), adding to the global rise of resistance as one observes for N. gonorrhoeae nowadays . Furthermore, the use of diagnostic tests could justify and strengthen the partner notification system, which is considered to be an essential part of STI management . Finally, it will give insight into the epidemiology and characteristics of the causative organisms and the option to monitor and conduct surveillance of these infectious diseases.…”

“…We therefore conclude that in this rural population with a high burden of STI that are left untreated under the current syndromic management approach (targeted), introduction of diagnostic tests is crucial for reducing the burden of infection. Despite the higher cost associated with diagnostic tests compared to the syndromic management approach, data from modelling and feasibility studies suggest that diagnostic testing, especially in high‐prevalence populations such as sex workers and pregnant women, may be a cost‐effective and feasible strategy . Further research to explore the feasibility, performance and cost‐effectiveness of such an approach in routine healthcare programmes in low‐resource settings is warranted.…”

Evaluation of Cortez Onestep Chlamydia RapicardTM Insta Test for the Detection of Chlamydia Trachomatis in Pregnant Women at Mbare Polyclinic in Harare, Zimbabwe

“…Pregnancy complications, including ectopic pregnancy, premature delivery, low birth weight, stillbirths and neonatal death have been cited in the literature. [ 2 , 3 ] Other pregnancy complications include premature rapture of membranes, gestational bleeding, amnionitis, neonatal and puerperal infections. [ 3 ]…”

Development of a Point-of-Care HIV/Aids Medication Dosing Support System Using the Android Mobile Platform

“…Provider-facing point-of-care (POC) applications that provide decision support at the point-of-need, show promise in improving the overall quality of care, especially for remote and underserved populations [8][9][10]. Improved access to medical decision support will likely lead to improvement in the quality of care provided, and ultimately improvements in treatment outcomes [11].…”