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

Abstract

BackgroundHIV 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.MethodsA 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.ResultsA 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.ConclusionsFindings 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.

Toward Improving Accessibility of Point-of-Care Diagnostic Services for Maternal and Child Health in Low- and Middle-Income Countries

“…32–34,43,44 The impact of antenatal RST in increasing uptake and treatment rates has also been highlighted in some studies. 37,70–73 Although the review has shown the inclusion of molecular techniques, which are more sensitive, for example, for early diagnosis of HIV infection in infants 41,42 and for screening for malaria in pregnant women, 86 there is still a need for high-quality assays in remote and rural primary care settings. The review also found varied performance of HRP2 RDT, particularly for asymptomatic malaria, which can still be used although it would miss some malaria cases.…”

“…37 The study also found that the costs for dual testing for HIV/syphilis and treatment for syphilis are high. 37 Dual HIV/syphilis testing represents an important opportunity for PMTCT of HIV and syphilis.…”

“…49,70–72,74,75 Studies have shown that integration of RST in the context of ANC improves pregnant women uptake of syphilis testing 70–73 and treatment rates. 37,71 Nonetheless, studies have observed nonsignificant increases in syphilis testing uptake 49,74 and treatment 71 due to test kit stock-outs. Dual HIV/syphilis rapid diagnostic tests (RDTs) that can detect both HIV and syphilis at the same time during a single clinic visit are also available.…”

“…Dual HIV/syphilis rapid diagnostic tests (RDTs) that can detect both HIV and syphilis at the same time during a single clinic visit are also available. 37 A cluster-randomized controlled study has shown the potential for dual HIV/syphilis RDT on timely treatment for women who tested positive for syphilis. 37 The study also found that the costs for dual testing for HIV/syphilis and treatment for syphilis are high.…”

“…37 A cluster-randomized controlled study has shown the potential for dual HIV/syphilis RDT on timely treatment for women who tested positive for syphilis. 37 The study also found that the costs for dual testing for HIV/syphilis and treatment for syphilis are high. 37 Dual HIV/syphilis testing represents an important opportunity for PMTCT of HIV and syphilis.…”