Objective Point-of-care (POC) management may avert ongoing transmissions occurring between testing and treatment or due to loss to follow-up. We modelled the impact of POC management of anogenital gonorrhoea (with light microscopic evaluation of Gram stained smears) among men who have sex with men (MSM) on gonorrhoea prevalence and testing and treatment costs.
Methods Data concerning costs and sexual behaviour were collected from the STI clinic of Amsterdam. With a deterministic model for gonorrhoea transmission, we calculated the prevalence of gonorrhoea in MSM in Amsterdam and the numbers of consultations at our clinic over 5 years, in three testing scenarios: POC for symptomatic MSM only (currently routine), 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, of whom 22.9% (25/109) had unprotected anal intercourse. Expanding POC testing from symptomatic MSM to all MSM could result in an 11% decrease (IQR, 8%–15%) in gonorrhoea prevalence after 5 years and a cost increase of 8.6% (€2.40) per consultation and €86 118 overall (+8.3%). Switching from POC testing of symptomatic MSM to no POC testing could save €1.83 per consultation (6.5%) and €54 044 (−5.2%) after 5 years with a 60% (IQR, 26%–127%) gonorrhoea prevalence increase. Overtreatment was 2.1% (30/1411) with POC for symptomatic MSM only and 4.1% (68/1675) with POC for all MSM.
Conclusions In the Amsterdam setting, possible abandonment of POC testing of symptomatic MSM because of budget cuts could result in a considerable increase in gonorrhoea prevalence against a reduction in costs per consultation. Expanding POC testing to all MSM could result in a modest reduction in prevalence and a cost increase. While the costs and outcomes depend on specific local characteristics, the developed framework of this study is useful to evaluate POC management in other settings.
- Neisseria Gonorrhoeae
- cost-effectiveness analysis
- point-of-care systems
- mathematical model
- infection transmission
- lost to follow-up
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Handling editor Jackie A Cassell
Contributors MX, HJCdV and MB were the authors responsible for the design of the study. MX designed the mathematical model. MSvR and MB collected and interpreted the sexual behaviour data. KV collected and analysed the data of the costs. MB and MX drafted the paper. HJCdV and MX supervised the overall study. All authors reviewed and approved the final article.
Funding This study was financed by the Research and Development department of the Public Health Service of Amsterdam (No 2382).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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