Background For HIV-infected men who have sex with men (MSM), implementation of routine STI screening into care at HIV treatment centres can substantially reduce STI incidence and possibly HIV incidence in the MSM population. Some countries already combine STI and HIV care, but its cost-effectiveness has not been explored. This study was designed to estimate the cost-effectiveness of providing routine anorectal chlamydia screening to MSM in care at HIV treatment centres in the Netherlands, where STI and HIV care are not currently combined.
Method Outcomes of a transmission model describing the sexual transmission of HIV and chlamydia in MSM over a 20-year period were used as input for an economic model. Inclusion of multiple STIs were not allowed due to the complexity of the transmission model. The incremental cost-effectiveness ratio (ICER) was calculated for four scenarios: once- and twice-yearly routine chlamydia screening at HIV treatment centres among MSM who do/do not seek screening elsewhere.
Results Costs will be saved by routine chlamydia screening of MSM in care at HIV treatment centres if these patients seek little or no screening elsewhere. Opportunistic screening is considerably more expensive than routine screening offered within a scheduled visit. Adding once-yearly chlamydia screening for MSM in care at HIV treatment centres is cost-saving when 30% or fewer of those men seek once-yearly screening elsewhere. Twice-yearly routine screening at HIV treatment centres is cost-effective only when no opportunistic screening takes place.
Conclusion Adding annual chlamydia screening to the HIV consultation will be cost-saving as long as only a limited proportion of men are opportunistically screened. The ICER was most sensitive to the percentage of MSM that continue to be screened elsewhere.
- chlamydia screening
- HIV Prevention
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