Economic evaluation of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low- and middle-income countries: A systematic review

Abstract

Background Sexually transmitted and genital infections in pregnancy are associated with adverse pregnancy and birth outcomes. Point-of-care tests for these infections facilitate testing and treatment in a single antenatal clinic visit and may reduce the risk of adverse outcomes. Successful implementation and scale-up depends on understanding comparative effectiveness of such programmes and their comparative costs and cost effectiveness. This systematic review synthesises and appraises evidence from economic evaluations of point-of-care testing and treatment for sexually transmitted and genital infections among pregnant women in low- and middle-income countries. Methods Medline, Embase and Web of Science databases were comprehensively searched using pre-determined criteria. Additional literature was identified by searching Google Scholar and the bibliographies of all included studies. Economic evaluations were eligible if they were set in low- and middle-income countries and assessed antenatal point-of-care testing and treatment for syphilis, chlamydia, gonorrhoea, trichomoniasis, and/or bacterial vaginosis. Studies were analysed using narrative synthesis. Methodological and reporting standards were assessed using two published checklists. Results Sixteen economic evaluations were included in this review; ten based in Africa, three in Latin and South America and three were cross-continent comparisons. Fifteen studies assessed point-of-care testing and treatment for syphilis, while one evaluated chlamydia. Key drivers of cost and cost-effectiveness included disease prevalence; test, treatment, and staff costs; test sensitivity and specificity; and screening and treatment coverage. All studies met 75% or more of the criteria of the Drummond Checklist and 60% of the Consolidated Health Economics Evaluation Reporting Standards. Conclusions Generally, point-of-care testing and treatment was cost-effective compared to no screening, syndromic management, and laboratory-based testing. Future economic evaluations should consider other common infections, and their lifetime impact on mothers and babies. Complementary affordability and equity analyses would strengthen the case for greater investment in antenatal point-of-care testing and treatment for sexually transmitted and genital infections.

High Cure Rate Among Pregnant Women in a Chlamydia trachomatis and Neisseria gonorrhoeae Testing and Treatment Intervention Study in Gaborone, Botswana

“…In LMICs, a major barrier to scale-up of etiologic STI testing is cost. 22 In resource-constrained settings where reporting of multiple partners is low and partner treatment is well documented, it may be feasible to reduce STI testing costs by removing the recommendation for a routine test of cure.…”

“…As countries consider expanding the availability of STI testing during antenatal care, decisions must be made about when to offer screening and whether and when to offer tests of cure and rescreening. In LMICs, a major barrier to scale-up of etiologic STI testing is cost 22 . In resource-constrained settings where reporting of multiple partners is low and partner treatment is well documented, it may be feasible to reduce STI testing costs by removing the recommendation for a routine test of cure.…”

Bacterial Vaginosis Monitoring with Carbon Nanotube Field-Effect Transistors

“…Rapid point-ofcare (POC) screening for the presence of BV-related biomolecules may provide an early indication of women at risk for BV-related pregnancy diseases regardless of symptomology. 10 Recent studies suggest the displacement of healthpromoting vaginal bacteria (i.e., Lactobacillus spp.) and outgrowth of potential pathogenic bacteria are associated with increased levels of biochemicals known as biogenic amines (e.g., putrescine, cadaverine, and tyramine) and elevated vaginal pH.…”

“…Other methods sufficient to identify asymptomatic BV, such as microscopy (i.e., Nugent criteria) or molecular diagnostics, vary in their availability for women due to differences in healthcare access. Rapid point-of-care (POC) screening for the presence of BV-related biomolecules may provide an early indication of women at risk for BV-related pregnancy diseases regardless of symptomology . Recent studies suggest the displacement of health-promoting vaginal bacteria (i.e., Lactobacillus spp.)…”

Point-of-care testing and treatment of sexually transmitted and genital infections during pregnancy in Papua New Guinea (WANTAIM trial): protocol for an economic evaluation alongside a cluster-randomised trial

“…In recent years, the evidence base for the cost and costeffectiveness of PoC testing for STIs in pregnancy has grown, including in LMICs. A recent systematic review 34 identified that the bulk of these studies was conducted in Africa or Latin and South America, [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] with no studies undertaken in East Asia or the Pacific. Most of the studies investigated the cost and cost-effectiveness of PoC testing for syphilis in pregnancy compared with no screening, syndromic management or onsite laboratory testing.…”