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Cost-Effectiveness Analysis of Annual Trichomonas vaginalis Screening and Treatment in HIV-Positive Women to Prevent HIV Transmission

Lazenby, Gweneth Bratton MD, MSCR*; Unal, Elizabeth Ramsey MD, MSCR; Andrews, Annie Lintzenich MD, MSCR; Simpson, Kit DrPH§

Sexually Transmitted Diseases: June 2014 - Volume 41 - Issue 6 - p 353–358
doi: 10.1097/OLQ.0000000000000008
Original Study

Background Because of a high incidence of Trichomonas infection among HIV-positive women, annual screening and treatment are recommended. Trichomonas infection is associated with a 2-fold risk of HIV transmission. The objective of this study was to determine if annual screening is cost-effective for the prevention of new HIV cases in susceptible male partners secondary to Trichomonas infection in HIV-positive women.

Methods A decision tree analysis was constructed to model the costs of Trichomonas screening, treatment, and follow-up. 200 women cycled through the model for a period of 12 months. One hundred women were unscreened and 100 were screened and treated per recommendations.

Results Annual Trichomonas screening and treatment saves US$553 (US$475– US$645) per woman in the prevention of HIV transmission to male partners. The cost-effectiveness of this strategy was maintained across all assumptions in a sensitivity analysis.

Conclusions Trichomonas screening and treatment for the purpose of decreasing new HIV infections is not only cost-effective but also cost saving in HIV-positive women. If Centers for Disease Control and Prevention treatment guidelines were followed in all HIV-positive women living in the United States, the lifetime cost of new HIV infections prevented would approximate US$159,264,000 and could potentially prevent new HIV cases secondary to female-to-male transmissions.

This study demonstrates that annual screening and treatment of Trichomonas vaginalis infection in of HIV-positive women is a cost-effective strategy for the prevention of HIV transmission to susceptible partners.

From the *Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC; †Department of Obstetrics and Gynecology Division of Maternal Fetal Medicine, Southern Illinois University, Carbondale, IL; and Departments of ‡Pediatrics and §Health Science and Research, Medical University of South Carolina, Charleston, SC

Disclosure: No conflicts of interests to disclose or sources of support to report.

Correspondence: Gweneth B. Lazenby, MD, MSCR, Medical University of South Carolina c/o Department of Obstetrics and Gynecology, 96 Jonathon Lucas St, Suite 634, Charleston, SC 29425. E-mail:

Received for publication November 11, 2012, and accepted June 3, 2013.

© Copyright 2014 American Sexually Transmitted Diseases Association