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The Cost-Effectiveness of Screening Men Who Have Sex With Men for Rectal Chlamydial and Gonococcal Infection to Prevent HIV Infection

Chesson, Harrell W. PhD*; Bernstein, Kyle T. PhD; Gift, Thomas L. PhD*; Marcus, Julia L. MPH; Pipkin, Sharon MPH; Kent, Charlotte K. PhD*

Sexually Transmitted Diseases: May 2013 - Volume 40 - Issue 5 - p 366–371
doi: 10.1097/OLQ.0b013e318284e544
Original Study

Background Men who have sex with men (MSM) who have a current or recent history of rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infection are at greater risk for HIV than MSM with no history of rectal infection. Screening and treating MSM for rectal CT/GC infection may help reduce any increased biological susceptibility to HIV infection.

Methods We used 2 versions of a Markov state-transition model to examine the impact and cost-effectiveness of screening MSM for rectal CT/GC infection in San Francisco: a static version that included only the benefits to those screened and a dynamic version that accounted for population-level impacts of screening. HIV prevention through reduced susceptibility to HIV was the only potential benefit of rectal CT/GC screening that we included in our analysis. Parameter values were based on San Francisco program data and the literature.

Results In the base case, the cost per quality-adjusted life year gained through screening MSM for rectal CT/GC infection was $16,300 in the static version of the model. In the dynamic model, the cost per quality-adjusted life year gained was less than $0, meaning that rectal screening was cost-saving. The impact of rectal CT/GC infection on the risk of HIV acquisition was the most influential model parameter.

Conclusions Although more information is needed regarding the impact of rectal CT/GC screening on HIV incidence, rectal CT/GC screening of MSM can potentially be a cost-effective, scalable intervention targeted to at-risk MSM in certain urban settings such as San Francisco.

In many scenarios, screening men who have sex with men for rectal Chlamydia trachomatis/Neisseria gonorrhoeae infection could pay for itself in terms of averted costs of HIV. Supplemental Digital Content is available in the article.

From the *Centers for Disease Control and Prevention, Atlanta, GA; and †San Francisco Department of Public Health, San Francisco, CA

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Correspondence: Harrell W. Chesson, PhD, CDC Mailstop E-80, 1600 Clifton Rd, Atlanta, GA 30333. E-mail:

Received for publication July 23, 2012, and accepted December 26, 2012.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

© Copyright 2013 American Sexually Transmitted Diseases Association