Costing of National STI Program Implementation for the Global STI Control Strategy for the Health Sector, 2016-2021

Abstract

Introduction: In 2016 the World Health Assembly adopted the global strategy on Sexually Transmitted Infections (STI) 2016-2021 aiming to reduce curable STIs by 90% by 2030. We costed scaling-up priority interventions to coverage targets.

Methods: Strategy-targeted declines in Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Trichomonas vaginalis were applied to WHO-estimated regional burdens at 2012. Syndromic case management was costed for these curable STIs, symptomatic Herpes Simplex Virus 2 (HSV-2), and non-STI vaginal syndromes, with incrementally expanding etiologic diagnosis. Service unit costs were multiplied with clinic attendances and people targeted for screening or prevention, by income tier. Human papilloma virus (HPV) vaccination and screening were costed for coverage increasing to 60% of 10-year-old girls for vaccination, and 60% of women 30-49 years for twice-lifetime screening (including clinical follow-up for positive screens), by 2021.

Results: Strategy implementation will cost an estimated US$ 18.1 billion over 2016-2021 in 117 low- and middle-income countries. Cost drivers are HPV vaccination ($3.26 billion) and screening ($3.69 billion), adolescent chlamydia screening ($2.54 billion), and antenatal syphilis screening ($1.4 billion). Clinical management-of 18 million genital ulcers, 29-39 million urethral discharges and 42-53 million vaginal discharges annually-will cost $3.0 billion, including $818 million for service delivery and $1.4 billion for gonorrhea and chlamydia testing. Global costs increase from $2.6 billion to $ 4.0 billion over 2016-2021, driven by HPV services scale-up, despite vaccine price reduction. Sub-Saharan Africa, bearing 40% of curable STI burdens, covers 44% of global service needs and 30% of cost, the Western Pacific 15% of burden/need and 26% of cost, South-East Asia 20% of burden/need and 18% of cost.

Conclusions: Costs of global STI control depend on price trends for HPV vaccines and chlamydia tests. Middle-income and especially low-income countries need increased investment, innovative financing, and synergizing with other health programs.

Fig 1. Numbers of curable STI episodes, by diagnostic and treatment status, 117 low- and middle-income countries.

Estimated based on the WHO’s 2012STI burden estimates for 2015, with extrapolation to 2021 reflecting the global STI strategy’s burden reduction and diagnostic and treatment coverage targets, as described in Methods and in Table 1.

Fig 2. Numbers of genito-urinal syndromes presenting for case management at STI clinics, by diagnostic and treatment status, 117 low- and middle-income countries, 117 low- and middle-income countries.

Estimated based on the WHO’s 2012 STI burden estimates for 2015, with extrapolation to 2021 reflecting the global STI strategy’s burden reduction and diagnostic and treatment coverage targets, as described in Methods and in Table 1. The estimated annual GUD cases total 16.2 million in both 2015 and 2021; the y-axis was capped at a lower maximum for readability of the shown sub-sets of cases.