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, 40 (5), 366-71

The Cost-Effectiveness of Screening Men Who Have Sex With Men for Rectal Chlamydial and Gonococcal Infection to Prevent HIV Infection

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The Cost-Effectiveness of Screening Men Who Have Sex With Men for Rectal Chlamydial and Gonococcal Infection to Prevent HIV Infection

Harrell W Chesson et al. Sex Transm Dis.

Abstract

Background: Men who have sex with men (MSM) who have a current or recent history of rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infection are at greater risk for HIV than MSM with no history of rectal infection. Screening and treating MSM for rectal CT/GC infection may help reduce any increased biological susceptibility to HIV infection.

Methods: We used 2 versions of a Markov state-transition model to examine the impact and cost-effectiveness of screening MSM for rectal CT/GC infection in San Francisco: a static version that included only the benefits to those screened and a dynamic version that accounted for population-level impacts of screening. HIV prevention through reduced susceptibility to HIV was the only potential benefit of rectal CT/GC screening that we included in our analysis. Parameter values were based on San Francisco program data and the literature.

Results: In the base case, the cost per quality-adjusted life year gained through screening MSM for rectal CT/GC infection was $16,300 in the static version of the model. In the dynamic model, the cost per quality-adjusted life year gained was less than $0, meaning that rectal screening was cost-saving. The impact of rectal CT/GC infection on the risk of HIV acquisition was the most influential model parameter.

Conclusions: Although more information is needed regarding the impact of rectal CT/GC screening on HIV incidence, rectal CT/GC screening of MSM can potentially be a cost-effective, scalable intervention targeted to at-risk MSM in certain urban settings such as San Francisco.

Figures

Figure 1.
Figure 1.
Illustration of the model. The 4 health states are mutually exclusive, and transition occurs when rectal CT/GC infection is acquired, when rectal CT/GC infection is cleared, or when HIV is acquired. The HIV incidence rate among those without rectal CT/GC infection is λHIVHIV, where λHIV is the HIV incidence at the onset of the screening program and HIV is an adjustment factor to account for changes in the prevalence of HIV in sex partners over time. The rate of HIV incidence among those with rectal CT/GC infection is assumed to be ϴ times that of those without rectal CT/GC infection. The incidence rate of rectal CT/GC infection is λSTDSTD and λ^STDΩSTD among those without and with HIV, respectively, where λSTD and λ^STD are the incidence rates of rectal CT/GC infection at the onset of the screening program among those without and with HIV, respectively, and STD is an adjustment factor to account for changes in the prevalence of CT and GC in sex partners over time as a result of the screening program. The clearance rate of rectal CT/GC infection (r) is a function of 2 factors: duration of infection and screening rates.

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