Introduction Point-of-care (POC) management (providing test results during the initial visit) may be more effective as testing policy than conventional testing (providing test results after days) by averting transmissions occurring between testing and treatment or due to loss to follow-up. We investigated the impact of POC management (with light microscopic examination of Gram stained smears) of anogenital gonorrhoea among men who have sex with men (MSM) on gonorrhoea prevalence and testing and treatment costs at the STI clinic of Amsterdam.
Methods Data on costs and sexual behaviour of MSM were collected at our clinic. With a deterministic model we described gonorrhoea transmission among MSM in Amsterdam; we calculated the prevalence of gonorrhoea, testing and treatment costs and the numbers of consultations over five years in our clinic, in three testing scenarios: POC for symptomatic MSM only (the current scenario), POC for all MSM, and no POC for MSM.
Results Among MSM, 34.7% (109/314) had sexual contacts in the period between testing and treatment (average of 13 days), of whom 22.9% (25/109) had unprotected anal intercourse. Expanding POC testing of symptomatic MSM to all MSM resulted in a 5 year decline in gonorrhoea prevalence of 10.7% (IQR, 8.2%–15.4%) at an increase of €2.40 (8.6%) per consultation and €86 118 overall (+8.3%). Switching from POC testing of symptomatic MSM to no POC testing increased prevalence by 59.9% (IQR, 25.6%–126.7%) with cost savings of 6.5% (€1.83) per consultation and €54 044 (-5.2%) in total costs after 5 years.
Conclusion The abandonment of POC gonorrhoea testing of symptomatic MSM would result in a high increase in gonorrhoea prevalence against a reduction in costs per consultation, while expanding to all MSM would result in a modest decrease in prevalence against a rise in costs per consultation. While the outcomes depend on specific local characteristics, such as the prevalence, loss to follow up, and sexual behaviour, the developed framework of this study can be useful to evaluate POC management in other settings.
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