Cost and cost-effectiveness of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low-income and middle-income countries: a systematic review protocol

• Published in: BMJ open Vol. 9; no. 11; p. e029945
• Main Authors: Saweri, Olga PM, Batura, Neha, Adawiyah, Rabiah al, Causer, Louise, Pomat, Willie, Vallely, Andrew, Wiseman, Virginia
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 14-11-2019; BMJ Publishing Group
• Subjects: Bacterial infections; Cost benefit analysis; Cost-Benefit Analysis - economics; Cost-Benefit Analysis - statistics & numerical data; Developing Countries; Evidence-based medicine; Female; Health Economics; Humans; LDCs; Medical laboratories; Medical treatment; Point of care testing; Point-of-Care Systems - economics; Point-of-Care Systems - statistics & numerical data; Point-of-Care Testing - economics; Point-of-Care Testing - statistics & numerical data; Poverty; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - therapy; Research Design; Sexually transmitted diseases; Sexually Transmitted Diseases - diagnosis; Sexually Transmitted Diseases - economics; Sexually Transmitted Diseases - therapy; STD; Systematic review; Womens health; cost-effectiveness; costs; sexually transmitted infections; genital infections; point-of-care; pregnancy
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2019-029945

IntroductionThe economic and health burden of sexually transmitted and genital infections (henceforth, STIs) in low-income and middle-income countries (LMICs) is substantial. Left untreated, STIs during pregnancy may result in several adverse pregnancy and birth outcomes. Timely diagnosis and treatment at point-of-care (POC) can potentially improve these outcomes. Despite the availability and promotion of POC diagnostics for STIs as a key component of antenatal care in LMICs, their widespread use has been limited, owing to the high economic costs faced by individuals and health systems. To date, there have been no systematic reviews which explore the cost or cost-effectiveness of POC testing and treatment of STIs in pregnancy in LMICs. The objective of this protocol is to outline the methods that will compare, synthesise and appraise the existing literature in this domain.Methods and analysisWe will conduct literature searches in MEDLINE, Embase and Web of Science. To find additional literature, we will search Google Scholar and hand search reference lists of included papers. Two reviewers will independently search databases, screen titles, abstracts and full texts; when necessary a third reviewer will resolve disputes. Only cost and cost-effectiveness studies of POC testing and treatment of STIs, including syphilis, chlamydia, trichomonas, gonorrhoea and bacterial vaginosis, in pregnancy in LMICs will be included. Published checklists will be used to assess quality of reporting practices and methodological approaches. We will also assess risk of publication bias. Interstudy heterogeneity will be assessed and depending on variation between studies, a meta-analysis or narrative synthesis will be conducted.Ethics and disseminationEthical approval is not required as the review will use published literature. The results will be published in a peer-reviewed open source journal and presented at an international conference.PROSPERO registration numberCRD42018109072.