Cost and cost-effectiveness of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low-income and middle-income countries: a systematic review protocol

doi:10.1136/bmjopen-2019-029945

. 2019 Nov 14;9(11):e029945.

doi: 10.1136/bmjopen-2019-029945.

Cost and cost-effectiveness of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low-income and middle-income countries: a systematic review protocol

Olga Pm Saweri^{1

2}, Neha Batura³, Rabiah Al Adawiyah⁴, Louise Causer⁵, Willie Pomat⁶, Andrew Vallely^{4

7}, Virginia Wiseman^{8

9}

Affiliations

¹ The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia nsaweri@kirby.unsw.edu.au.
² Population Health and Demography, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
³ Institute for Global Health, University College London, London, UK.
⁴ The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
⁵ Sexual Health Program, Kirby Insitute, Sydney, New South Wales, Australia.
⁶ Infection and Immunity, PNG Institute of Medical Research, Goroka, Papua New Guinea.
⁷ Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
⁸ School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia.
⁹ Health Ecoomics, LSHTM, London, UK.

PMID: 31727649
PMCID: PMC6887066
DOI: 10.1136/bmjopen-2019-029945

Cost and cost-effectiveness of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low-income and middle-income countries: a systematic review protocol

Olga Pm Saweri et al. BMJ Open. 2019.

. 2019 Nov 14;9(11):e029945.

doi: 10.1136/bmjopen-2019-029945.

Authors

Olga Pm Saweri^{1

2}, Neha Batura³, Rabiah Al Adawiyah⁴, Louise Causer⁵, Willie Pomat⁶, Andrew Vallely^{4

7}, Virginia Wiseman^{8

9}

Affiliations

¹ The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia nsaweri@kirby.unsw.edu.au.
² Population Health and Demography, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
³ Institute for Global Health, University College London, London, UK.
⁴ The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
⁵ Sexual Health Program, Kirby Insitute, Sydney, New South Wales, Australia.
⁶ Infection and Immunity, PNG Institute of Medical Research, Goroka, Papua New Guinea.
⁷ Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
⁸ School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia.
⁹ Health Ecoomics, LSHTM, London, UK.

PMID: 31727649
PMCID: PMC6887066
DOI: 10.1136/bmjopen-2019-029945

Abstract

Introduction: The economic and health burden of sexually transmitted and genital infections (henceforth, STIs) in low-income and middle-income countries (LMICs) is substantial. Left untreated, STIs during pregnancy may result in several adverse pregnancy and birth outcomes. Timely diagnosis and treatment at point-of-care (POC) can potentially improve these outcomes. Despite the availability and promotion of POC diagnostics for STIs as a key component of antenatal care in LMICs, their widespread use has been limited, owing to the high economic costs faced by individuals and health systems. To date, there have been no systematic reviews which explore the cost or cost-effectiveness of POC testing and treatment of STIs in pregnancy in LMICs. The objective of this protocol is to outline the methods that will compare, synthesise and appraise the existing literature in this domain.

Methods and analysis: We will conduct literature searches in MEDLINE, Embase and Web of Science. To find additional literature, we will search Google Scholar and hand search reference lists of included papers. Two reviewers will independently search databases, screen titles, abstracts and full texts; when necessary a third reviewer will resolve disputes. Only cost and cost-effectiveness studies of POC testing and treatment of STIs, including syphilis, chlamydia, trichomonas, gonorrhoea and bacterial vaginosis, in pregnancy in LMICs will be included. Published checklists will be used to assess quality of reporting practices and methodological approaches. We will also assess risk of publication bias. Interstudy heterogeneity will be assessed and depending on variation between studies, a meta-analysis or narrative synthesis will be conducted.

Ethics and dissemination: Ethical approval is not required as the review will use published literature. The results will be published in a peer-reviewed open source journal and presented at an international conference.

Prospero registration number: CRD42018109072.

Keywords: cost-effectiveness; costs; genital infections; point-of-care; pregnancy; sexually transmitted infections.

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Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
PreferredReporting Items for Systematic Reviews and Meta-Analyses flow diagram of the search selection for this systematic review.

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References

1. WHO Sexually transmitted infections (STIs): the importance of a renewed commitment to STI prevention and control in achieving global sexual and reproductive health. Geneva, Switzerland: WHO, 2012: 8.
1. Klausner JD, Broutet N. Health systems and the new strategy against sexually transmitted infections. Lancet Infect Dis 2017;17:797–8. 10.1016/S1473-3099(17)30361-4 - DOI - PubMed
1. Adachi K, Nielsen-Saines K, Klausner JD. Chlamydia trachomatis infection in pregnancy: the global challenge of preventing adverse pregnancy and infant outcomes in sub-Saharan Africa and Asia. Biomed Res Int 2016. 10.1155/2016/9315757 - DOI - PMC - PubMed
1. Newman L, Kamb M, Hawkes S, et al. . Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data. PLoS Med 2013;10:e1001396 10.1371/journal.pmed.1001396 - DOI - PMC - PubMed
1. Hook EW. Syphilis. The Lancet 2017;389:1550–7. 10.1016/S0140-6736(16)32411-4 - DOI - PubMed

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[1] WHO Sexually transmitted infections (STIs): the importance of a renewed commitment to STI prevention and control in achieving global sexual and reproductive health. Geneva, Switzerland: WHO, 2012: 8.

[2] WHO Sexually transmitted infections (STIs): the importance of a renewed commitment to STI prevention and control in achieving global sexual and reproductive health. Geneva, Switzerland: WHO, 2012: 8.

[3] Klausner JD, Broutet N. Health systems and the new strategy against sexually transmitted infections. Lancet Infect Dis 2017;17:797–8. 10.1016/S1473-3099(17)30361-4 - DOI - PubMed

[4] Klausner JD, Broutet N. Health systems and the new strategy against sexually transmitted infections. Lancet Infect Dis 2017;17:797–8. 10.1016/S1473-3099(17)30361-4 - DOI - PubMed

[5] Adachi K, Nielsen-Saines K, Klausner JD. Chlamydia trachomatis infection in pregnancy: the global challenge of preventing adverse pregnancy and infant outcomes in sub-Saharan Africa and Asia. Biomed Res Int 2016. 10.1155/2016/9315757 - DOI - PMC - PubMed

[6] Adachi K, Nielsen-Saines K, Klausner JD. Chlamydia trachomatis infection in pregnancy: the global challenge of preventing adverse pregnancy and infant outcomes in sub-Saharan Africa and Asia. Biomed Res Int 2016. 10.1155/2016/9315757 - DOI - PMC - PubMed

[7] Newman L, Kamb M, Hawkes S, et al. . Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data. PLoS Med 2013;10:e1001396 10.1371/journal.pmed.1001396 - DOI - PMC - PubMed

[8] Newman L, Kamb M, Hawkes S, et al. . Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data. PLoS Med 2013;10:e1001396 10.1371/journal.pmed.1001396 - DOI - PMC - PubMed

[9] Hook EW. Syphilis. The Lancet 2017;389:1550–7. 10.1016/S0140-6736(16)32411-4 - DOI - PubMed

[10] Hook EW. Syphilis. The Lancet 2017;389:1550–7. 10.1016/S0140-6736(16)32411-4 - DOI - PubMed

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Cost and cost-effectiveness of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low-income and middle-income countries: a systematic review protocol

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Cost and cost-effectiveness of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low-income and middle-income countries: a systematic review protocol

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