Costs Associated With Incorporation of Network Approaches Into Sexually Transmitted Disease Program Activities

Abstract

Background: Network approaches can be used to study sociosexual partnerships and identify individuals at high risk of infection. Little is known about the cost structure of these services and their association with STD diagnoses. Method:We collected costs associated with using a peer network strategy to recruit men who have sex with men and transwomen of color in 4 counties in North Carolina: Guilford, Forsyth, Durham, and Wake from February through October 2019. We used a comprehensive costing approach to gather detailed retrospective information on the intervention cost, broken down by category and programmatic activity. Results:The sociosexual networks collected consisted of 31 initial seeds (index cases) and 49 peers of those seeds. In peers, 5 cases of human immunodeficiency virus (HIV) and 10 cases of syphilis were identified. The cost per case (HIV or syphilis) identified was $7325. Personnel costs accounted for 80% of total expenditures, followed by laboratory expenses (12%). Personnel cost was distributed between disease intervention specialist patient navigators (51%), nonclinical (37%), and management (12%) staff. General administration was the costliest programmatic activity (37%), followed by case management and field services (37%), and study activities (11%). The estimated average cost per patient tested was $2242.Conclusions: Finding positive peer cases in nonclinical settings is costly but may be crucial for limiting the spread of sexually transmitted diseases. The cost of staff was the major driver. This study demonstrates that using a network strategy can be a cost-effective way to identify, test, and refer patients at high risk of syphilis and HIV infections to care.

Cost-Effectiveness Considerations for Disease Intervention

“…Currently, there is limited evidence on the cost-effectiveness of DIS activities. [7][8][9]14 When evaluating the cost-effectiveness of one's own program, often new data collection efforts will be required. This requires foresight and planning to conduct high-quality costeffectiveness studies.…”

“…As the DIS workforce is strengthened and expanded, knowledge of how to efficiently use DIS becomes increasingly important. Currently, there is limited evidence on the cost-effectiveness of DIS activities 7–9,14 . When evaluating the cost-effectiveness of one's own program, often new data collection efforts will be required.…”

“…Collecting costs on DIS interventions comes with its own complexities. Disease intervention specialists typically spend their time on a variety of activities, and personnel is often the largest component of a program's cost, 14 so precisely mapping out the relevant components of the intervention of interest and correctly apportioning staff time and salaries is critical. This may require a time and motion study that measures the amount of time a DIS spends on each activity over a representative period 15 .…”

“…This may require a time and motion study that measures the amount of time a DIS spends on each activity over a representative period 15 . For example, Williams et al 14 collected data on mileage and travel time for DIS because their services required frequent travel. Collecting this type of data may have the added benefit of identifying operational inefficiencies.…”