Cost and cost-effectiveness of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low-income and middle-income countries: a systematic review protocol

Saweri, Olga PM; Batura, Neha; Adawiyah, Rabiah Al; Causer, Louise; Pomat, Willie; Vallely, Andrew; Wiseman, Virginia

doi:10.1136/bmjopen-2019-029945

Cited by 9 publications

(12 citation statements)

References 27 publications

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“…Syphilis remains a public health problem. There were an estimated 988,000 pregnant women infected with syphilis of which 52% experienced adverse pregnancy outcomes in 2016, including spontaneous abortions, stillbirths, preterm or low weight births, and clinical disease in infants 3,4 . Early diagnosis and immediate treatment with penicillin during antenatal care are highly effective in to the prevention of mother-to-child-transmission (PMTCT) 5–7 .…”

Section: Introductionmentioning

confidence: 99%

Treatment evaluation to improve preventing mother to child transmission among women with syphilis

Gong

Shao

Liu

et al. 2019

Sci Rep

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The aim of this study was to evaluate the effectiveness of preventing mother to child syphilis transmission to improve pregnancy outcomes. We performed a retrospective analysis of municipal databases of mother-to-child syphilis transmission. Pregnant women with syphilis were included. Group specific pregnancy outcomes were analyzed according to treatment. A total of 28 pregnant women were diagnosed with syphilis in 2012; 321 were diagnosed with syphilis in 2018. A prevalence of 0.14% was observed amongst pregnant women in Suzhou city from 2012–2018. Primary treatments included benzathine penicillin, ceftriaxone sodium or erythromycin when patients were allergic to Benzathine penicillin. The treatment coverage was 81.57%, and only 52.86% of pregnant women were adequately treated. Adverse pregnant outcomes were higher amongst untreated women. Expanding early screening coverage and promoting treatment were key to improving pregnancy outcomes amongst women with syphilis.

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Section: Introductionmentioning

confidence: 99%

Treatment evaluation to improve preventing mother to child transmission among women with syphilis

Gong

Shao

Liu

et al. 2019

Sci Rep

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“…This review has some limitations, with respect to the synthesis of key results, the significant variability in economic methods, particularly regarding the types of costs and outcomes measured, meant that the planned meta-analysis was not possible [ 54 ]. Further, few studies utilised a societal perspective to determine costs, which may have understated the true value associated with point-of-care testing and treatment for STIs in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…The methods for this review follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines ( S1 File ). The methodology summarised below adheres to the published systematic review protocol [ 54 ]. The review is registered in PROSPERO (CRD42018109072).…”

Section: Methodsmentioning

confidence: 99%

“…Data extraction highlighted the significant methodological heterogeneity between studies in terms of interventions, study design, cost categories, and health outcomes. Consequently, neither a meta-analysis nor a sub-group meta-analysis was able to be performed as originally envisaged [ 54 ]. The analysis for this review was limited to a descriptive summary and narrative synthesis.…”

Section: Methodsmentioning

confidence: 99%

“…neither a meta-analysis nor a sub-group meta-analysis was able to be performed as originally envisaged [54]. The analysis for this review was limited to a descriptive summary and narrative synthesis.…”

Section: Plos Onementioning

confidence: 99%

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Economic evaluation of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low- and middle-income countries: A systematic review

et al. 2021

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Background Sexually transmitted and genital infections in pregnancy are associated with adverse pregnancy and birth outcomes. Point-of-care tests for these infections facilitate testing and treatment in a single antenatal clinic visit and may reduce the risk of adverse outcomes. Successful implementation and scale-up depends on understanding comparative effectiveness of such programmes and their comparative costs and cost effectiveness. This systematic review synthesises and appraises evidence from economic evaluations of point-of-care testing and treatment for sexually transmitted and genital infections among pregnant women in low- and middle-income countries. Methods Medline, Embase and Web of Science databases were comprehensively searched using pre-determined criteria. Additional literature was identified by searching Google Scholar and the bibliographies of all included studies. Economic evaluations were eligible if they were set in low- and middle-income countries and assessed antenatal point-of-care testing and treatment for syphilis, chlamydia, gonorrhoea, trichomoniasis, and/or bacterial vaginosis. Studies were analysed using narrative synthesis. Methodological and reporting standards were assessed using two published checklists. Results Sixteen economic evaluations were included in this review; ten based in Africa, three in Latin and South America and three were cross-continent comparisons. Fifteen studies assessed point-of-care testing and treatment for syphilis, while one evaluated chlamydia. Key drivers of cost and cost-effectiveness included disease prevalence; test, treatment, and staff costs; test sensitivity and specificity; and screening and treatment coverage. All studies met 75% or more of the criteria of the Drummond Checklist and 60% of the Consolidated Health Economics Evaluation Reporting Standards. Conclusions Generally, point-of-care testing and treatment was cost-effective compared to no screening, syndromic management, and laboratory-based testing. Future economic evaluations should consider other common infections, and their lifetime impact on mothers and babies. Complementary affordability and equity analyses would strengthen the case for greater investment in antenatal point-of-care testing and treatment for sexually transmitted and genital infections.

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Associations of toluidine red unheated serum test response to the treatment of syphilis in pregnancy and congenital syphilis: a 10-year real-world study

Jin

Pang

Lun

2022

Chinese Medical Journal

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Background: So far, there is a paucity of real-world data on the syphilis serological responses to the first-line treatment during pregnancy, and there is no relevant study on the necessity of anti-syphilis treatment during pregnancy for those patients who have been treated for syphilis before pregnancy for the prevention of mother-to-child transmission, which might provide valuable insight into treatment effectiveness and optimal management of pregnant women with syphilis. Methods: A retrospective study on 10 years of real-world data was performed for accumulative 410 Chinese pregnant women with syphilis. The descriptive statistics were conducted in the study, and toluidine red unheated serum test (TRUST) titer responses to penicillin treatment in syphilis-infected pregnant women, and the associations with congenital syphilis were investigated. We divided the patients into two groups according to the history of anti-syphilis treatment before pregnancy (patients diagnosed with syphilis who had received anti-syphilis treatment before pregnancy, and patients screened and diagnosed with syphilis during pregnancy who had no previous history of anti-syphilis treatment). Results: The rate of congenital syphilis in this study was 6.2% (25/406). There was no significant difference in the rate of congenital syphilis between patients who received anti-syphilis treatment before pregnancy and those who did not. Secondary syphilis and high baseline serum TRUST titer (≥1:8) in pregnant women were independent risk factors for congenital syphilis. Conclusions: For the prevention of congenital syphilis, anti-syphilis treatment during pregnancy for syphilis seropositive pregnant women is needed, regardless of whether the patient has received anti-syphilis treatment before pregnancy, especially for those patients with secondary syphilis or high baseline serum TRUST titer, thus, timely surveillance, early diagnosis to timely treatment, and close syphilis reexamination during posttreatment follow-up, may help to reduce the above-mentioned risk factors for congenital syphilis.

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Cost and cost-effectiveness of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low-income and middle-income countries: a systematic review protocol

Cited by 9 publications

References 27 publications

Treatment evaluation to improve preventing mother to child transmission among women with syphilis

Treatment evaluation to improve preventing mother to child transmission among women with syphilis

Economic evaluation of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low- and middle-income countries: A systematic review

Associations of toluidine red unheated serum test response to the treatment of syphilis in pregnancy and congenital syphilis: a 10-year real-world study

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