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Sexually Transmitted Diseases:
doi: 10.1097/OLQ.0b013e3181574daa

Preventing Sexually Transmitted Infections among Incarcerated Men Who Have Sex With Men: A Cost-Effectiveness Analysis

Tuli, Karunesh MD, PhD; Kerndt, Peter R. MD, MPH

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Objectives: We assessed the cost-effectiveness of a screening, treatment, and condom provision intervention for inmates of a segregated unit for men who have sex with men at the Los Angeles County Men's Jail.

Goal: We conducted the study to determine whether the intervention provides good value for money.

Study Design: We used a mathematical model to examine the effect of 10 years of intervention on sexually transmitted infections in 3 scenarios for incarcerated men who have sex with men: (a) no sex; (b) sex as before incarceration; (c) as in #2 and condom use by 20% of screened inmates. We calculated cost-effectiveness ratios as net cost per infection averted after subtracting averted treatment costs from intervention costs.

Results: Modeling suggests that the intervention could avert 339 chlamydia, 276 gonorrhea, and 241 syphilis infections in scenario 1 (net cost $179,121); 593 chlamydia, 586 gonorrhea, and 367 syphilis infections in scenario 2 (with cost saving); and 746 chlamydia, 791 gonorrhea, 3 HIV, and 443 syphilis infections in scenario 3 (with cost saving).

Conclusions: Modeling indicates that the intervention can avert many sexually transmitted infections at low cost and can save costs in a scenario in which inmates continue to engage in sexual activity as they do outside jail. Modest success in efforts to promote condom use among inmates results in additional cost saving.

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