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A comparative analysis of costs of single and dual rapid HIV and syphilis diagnostics: results from a randomised controlled trial in Colombia

Abstract

Background HIV and congenital syphilis are major public health burdens contributing to substantial perinatal morbidity and mortality globally. Although studies have reported on the costs and cost-effectiveness of rapid diagnostic tests (RDTs) for syphilis screening within antenatal care in a number of resource-constrained settings, empirical evidence on country-specific cost and estimates of single RDTs compared with dual RDTs for HIV and syphilis are limited.

Methods A cluster randomised controlled study design was used to compare the incremental costs of two testing algorithms: (1) single RDTs for HIV and syphilis and (2) dual RDTs for HIV and syphilis, in 12 health facilities in Bogota and Cali, Colombia. The costs of single HIV and syphilis RDTs and dual HIV and syphilis RDTs were collected from each of the health facilities. The economic costs per woman tested for HIV and syphilis and costs per woman treated for syphilis defined as the total costs required to test and treat one woman for syphilis were estimated.

Results A total of 2214 women were tested in the study facilities. Cost per pregnant woman tested and cost per woman treated for syphilis were US$10.26 and US$607.99, respectively in the single RDT arm. For the dual RDTs, the cost per pregnant woman tested for HIV and syphilis and cost per woman treated for syphilis were US$15.89 and US$1859.26, respectively. Overall costs per woman tested for HIV and syphilis and cost per woman treated for syphilis were lower in Cali compared with Bogota across both intervention arms. Staff costs accounted for the largest proportion of costs while treatment costs comprised <1% of the preventive programme.

Conclusions Findings show lower average costs for single RDTs compared with dual RDTs with costs sensitive to personnel costs and the scale of output at the health facilities.

Trial registration number NCT02454816; results.

  • ANTENATAL HIV
  • LATIN AMERICA
  • SYPHILIS

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Footnotes

  • Handling editor Jackie A Cassell

  • Contributors CDO participated in the development of the study design, conducted analysis of the data and drafted the manuscript. RLS conducted cost data collection and contributed to the interpretation of results. LG contributed to the data collection, interpretation of results and writing of the manuscript. EA-M contributed to the interpretation of the results and writing of the manuscript contributed to the analysis of the data. ML contributed to the interpretation of the results and writing of the manuscript. LN contributed to the study design and overall supervision of the study. HG supervised all aspects of the study, including development of the study design, data analysis and interpretation of data and contributed to writing of the manuscript. FP contributed to the analysis of the data, interpretation of the results and writing the manuscript.

  • Funding This work was supported by the Bill and Melinda Gates Foundation and PATH through the Dual Testing to Eliminate Congenital Syphilis project and the UNDP/UNFPA/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction.

  • Disclaimer The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the article.

  • Competing interests None declared.

  • Ethics approval The study protocol was reviewed and approved by the Universidad Nacional de Colombia: evaluation report mo. 008-14 and WHO and WHO Research Ethics Review committee (WHO ERC) protocol no. A65875

  • Provenance and peer review Not commissioned; externally peer reviewed.

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