Cost-effectiveness of rapid syphilis screening in prenatal HIV testing programs in Haiti

Background New rapid syphilis tests permit simple and immediate diagnosis and treatment at a single clinic visit. We compared the cost- effectiveness, projected health outcomes, and annual cost of screening pregnant women using a rapid syphilis test as part of scaled- up prenatal testing to prevent mother- to- child HIV transmission in Haiti. Methods and Findings A decision analytic model simulated health outcomes and costs separately for pregnant women in rural and urban areas. We compared syphilis syndromic surveillance ( rural standard of care), rapid plasma reagin test with results and treatment at 1- wk follow- up ( urban standard of care), and a new rapid test with immediate results and treatment. Test performance data were from a World Health Organization - Special Programme for Research and Training in Tropical Diseases field trial conducted at the GHESKIO Center Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes in Port- au- Prince. Health outcomes were projected using historical data on prenatal syphilis treatment efficacy and included disability-adjusted life years ( DALYs) of newborns, congenital syphilis cases, neonatal deaths, and stillbirths. Cost- effectiveness ratios are in US dollars/ DALY from a societal perspective; annual costs are in US dollars from a payer perspective. Rapid testing with immediate treatment has a cost- effectiveness ratio of $ 6.83/ DALY in rural settings and $ 9.95/ DALY in urban settings. Results are sensitive to regional syphilis prevalence, rapid test sensitivity, and the return rate for follow- up visits. Integrating rapid syphilis testing into a scaled- up national HIV testing and prenatal care program would prevent 1,125 congenital syphilis cases and 1,223 stillbirths or neonatal deaths annually at a cost of $ 525,000. Conclusions In Haiti, integrating a new rapid syphilis test into prenatal care and HIV testing would prevent congenital syphilis cases and stillbirths, and is cost- effective. A similar approach may be beneficial in other resource- poor countries that are scaling up prenatal HIV testing.