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Cost-Effectiveness of Screening Men in Maricopa County Jails for Chlamydia and Gonorrhea to Avert Infections in Women

Gopalappa, Chaitra PhD*; Huang, Ya-Lin A. PhD*; Gift, Thomas L. PhD; Owusu-Edusei, Kwame PhD; Taylor, Melanie MD, MPH†‡§; Gales, Vincent RN, BSN

doi: 10.1097/OLQ.0000000000000023
Original Study

Background Chlamydia and gonorrhea infections can lead to serious and costly sequelae in women, but sequelae in men are rare. In accordance with the Centers for Disease Control and Prevention guidelines, female jail inmates in Maricopa County (Phoenix area), Arizona, are screened for these infections. Owing to lack of evidence of screening benefits in men, male inmates are tested and treated based on symptoms only.

Methods We developed a probabilistic simulation model to simulate chlamydia and gonorrhea infections in Maricopa County jail male inmates and transmissions to female partners per year. We estimated the cost-effectiveness of screening as the cost per infection averted. Costs were estimated from the perspective of the Maricopa County Department of Public Health and the Correctional Health Services.

Results Compared with symptom-based testing and treating strategy, screening male arrestees of all ages and only those 35 years or younger yielded the following results: averted approximately 556 and 491 cases of infection in women at a cost of approximately US $1240 and $860 per case averted, respectively, if screened during physical examination (between days 8 and 14 from entry to jail), and averted approximately 1100 and 995 cases of infections averted at a cost of US $1030 and $710 per infection averted, respectively, if screened early, within 2 to 3 days from entry to jail.

Conclusions Screening of male inmates incurs a modest cost per infection averted in women compared with symptom-based testing. Screening in correctional settings can be used by public health programs to reduce disease burden, sequelae, and associated costs.

The cost-effectiveness of universal and age-based screening for chlamydia and gonorrhea infections in male jail inmates of Maricopa County, Arizona, in averting transmissions to women was estimated.

From the Divisions of *HIV/AIDS Prevention and †STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA; ‡Arizona Department of Health Services and §Maricopa County Department of Public Health, STD Program, Phoenix, AZ; and ¶Maricopa County Correctional Health Services, Phoenix, AZ

The authors would like to acknowledge David Choate, Program Operations Manager, Center for Violence Prevention and Community Safety, Arizona State University, for help with data from the pilot screening study of jail inmates conducted by the Arizona Arrestee Reporting Information Network.

Disclosure: All authors were government employees at the time of the study and do not have any financial conflicts of interest to disclose. There were no additional sources of funding supporting this work.

Disclaimer: 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 or the Maricopa County Department of Public Health.

Correspondence: Chaitra Gopalappa, PhD, Futures Institute, 41-A New London Tpke, Glastonbury, CT 06033. E-mail: or

Chaitra Gopalappa’s work was conducted during employment at the Centers for Disease Control and Prevention. Current affiliation: Futures Institute, Glastonbury, CT

Received for publication March 12, 2013, and accepted June 25, 2013.

© Copyright 2013 American Sexually Transmitted Diseases Association