Rapid point of care testing for sexually transmitted diseases and bacterial vaginosis: cost estimation and budget impact analysis

Abstract

Sexually transmitted infections (STIs) remain a global public health concern. Together with bacterial vaginosis (BV), the association with HIV acquisition through genital inflammation in women poses a challenge towards the control of HIV/AIDS, more so in asymptomatic cases. Diagnosis of asymptomatic women using a genital inflammation screening tool, the cytokine biomarker rapid test, reduces the cases of untreated women. However, as a newly developed screening tool, there are no prior cost estimates to advocate for its funding and implementation. This study estimated the costs of genital inflammation screening of women (15-49 years) and, assessed the budget impact of providing this screening service in primary health facilities in South Africa in 2016. This thesis is a sub-study of the GIFT project (Genital Inflammation Test for HIV Prevention) whose main objective is HIV prevention through improved control of sexually transmitted infections (STIs). The micro-costing approach was used to calculate the unit cost per patient screened from a provider’s perspective at the Desmond Tutu HIV Foundation youth clinic (DTHF), and, the University of Cape Town Student Wellness Service (UCT SWS), over a 1 year period. The unit cost estimates were used to analyse the budget impact of scaling-up and providing the screening service in primary health facilities countrywide. . Sensitivity analyses were carried out to determine the robustness of the study findings. The results demonstrated that the cost per woman screened for genital inflammation was $24.26 at DTHF and$14.32 at UCT SWS. The scaled up costs ranged from $107,183,655 to$183,062,066 in South Africa. The screening intervention accounted for a significant amount of the available funds. The cost estimates were sensitive to the personnel costs, clinic utilization rates and population coverage rates. According to this study, it can be concluded that, the cost estimates of screening are high, and its implementation may not be affordable within the current budget. However, this screening tool will increase the cases detected, contributing towards better STIs management and control. Additionally, it will reduce the risk of HIV acquisition among women