Point-of-care screening for curable sexually transmitted infections in antenatal care in Zimbabwe: a costing study.

Abstract

Background: Sexually transmitted infections (STIs) including Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis during pregnancy are associated with adverse birth outcomes. However, there are limited published data available on cost estimates for implementing such screening. The aim of this study was to estimate the cost of integrating point-of-care STI screening into antenatal care in Harare, Zimbabwe, compared with a modelled standard of care (syndromic management).

Methods: We implemented screening for C. trachomatis, N. gonorrhoeae and T. vaginalis in antenatal care at two primary healthcare clinics in Harare, Zimbabwe, between 12 January 2023 and 23 October 2023. Economic costs required to deliver the testing strategy from a health system perspective were collected using a bespoke cost extraction tool based on study records, staff interviews, time-and-motion studies, local authority salary scales and other secondary sources. During the study, implementation within high-volume settings was found to not be operationally feasible, so implementation within a low-volume setting in routine care, without time required for research processes, was modelled for a 12-month period. The incremental cost per person screened and treated was calculated comparing point-of-care testing to a modelled standard of care using syndromic management.

Results: The composite prevalence of C. trachomatis, N. gonorrhoeae and/or T. vaginalis as measured in the intervention was 28.3% (283/1000). As a proportion of the total cost of the intervention, the largest components were test kits (55.4%), personnel (31.0%), and equipment costs (7.5%). The costs per person screened and treated were $41 and $146, respectively. The incremental costs per person screened and treated compared with syndromic management were $41 and $169, respectively.

Conclusion: The incremental cost per person screened and treated for an STI using a point-of-care antenatal screening strategy was driven by test kit and personnel costs, underlining the need for lower cost point-of-care STI diagnostics.

Trial registration number: NCT05541081.