Cost-effectiveness analysis of annual Trichomonas vaginalis screening and treatment in HIV-positive women to prevent HIV transmission

Sex Transm Dis. 2014 Jun;41(6):353-8. doi: 10.1097/OLQ.0000000000000008.


Background: Because of a high incidence of Trichomonas infection among HIV-positive women, annual screening and treatment are recommended. Trichomonas infection is associated with a 2-fold risk of HIV transmission. The objective of this study was to determine if annual screening is cost-effective for the prevention of new HIV cases in susceptible male partners secondary to Trichomonas infection in HIV-positive women.

Methods: A decision tree analysis was constructed to model the costs of Trichomonas screening, treatment, and follow-up. 200 women cycled through the model for a period of 12 months. One hundred women were unscreened and 100 were screened and treated per recommendations.

Results: Annual Trichomonas screening and treatment saves US $553 (US $475- US $645) per woman in the prevention of HIV transmission to male partners. The cost-effectiveness of this strategy was maintained across all assumptions in a sensitivity analysis.

Conclusions: Trichomonas screening and treatment for the purpose of decreasing new HIV infections is not only cost-effective but also cost saving in HIV-positive women. If Centers for Disease Control and Prevention treatment guidelines were followed in all HIV-positive women living in the United States, the lifetime cost of new HIV infections prevented would approximate US $159,264,000 and could potentially prevent new HIV cases secondary to female-to-male transmissions.

MeSH terms

  • Adult
  • Anti-Infective Agents / economics
  • Anti-Infective Agents / therapeutic use*
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Female
  • Follow-Up Studies
  • HIV Seropositivity / transmission*
  • Humans
  • Incidence
  • Male
  • Mass Screening / economics*
  • Metronidazole / economics
  • Metronidazole / therapeutic use*
  • Practice Guidelines as Topic
  • Quality-Adjusted Life Years
  • Sensitivity and Specificity
  • Trichomonas Vaginitis / diagnosis
  • Trichomonas Vaginitis / drug therapy*
  • Trichomonas Vaginitis / economics
  • Trichomonas vaginalis / isolation & purification*
  • United States / epidemiology


  • Anti-Infective Agents
  • Metronidazole