The cost-effectiveness of treating male trichomoniasis to avert HIV transmission in men seeking sexually transmitted disease care in Malawi.
OBJECTIVE
Allocation of funds to program areas where they may have an impact is critical to the success of any HIV control program. We examined the cost-effectiveness of providing first-line treatment for male trichomoniasis in Malawi, a condition not commonly considered in syndromic management throughout sub-Saharan Africa.


METHODS
We used decision tree analysis to assess program costs and outcomes among a 1-year population of male sexually transmitted disease (STD) clinic attendees estimated at 10,000 in Lilongwe. Our main outcomes were program costs from the government perspective and HIV infections averted. We conducted univariate and multivariate sensitivity analyses on selected parameters.


RESULTS
In our study population of male STD clinic attendees with an HIV prevalence of 44% and a Trichomonas vaginalis prevalence of 20%, including universal metronidazole as a first-line treatment for trichomoniasis at $0.05 per dose would increase program costs by $277 (year 2000 US dollars) and avert 23 cases of HIV. The incremental cost-effectiveness ratio (ICER) over the current STD management guidelines was $15.42 per case of HIV averted. The number of HIV infections averted under sensitivity analysis ranged from 2 to 52, with attendant ICERs varying from cost savings to $162.92. Consideration of wider social benefits, such as the costs of HIV infections to the individual or the government, would further enhance the cost-effectiveness of this program.


CONCLUSIONS
As part of a larger program to control STDs, incorporating metronidazole to treat male trichomoniasis could represent a cost-effective means to reduce HIV transmission in this high-risk group.
Price
Matthew A
MA
International AIDS Vaccine Initiative, New York, NY, USA. mprice@iavi.org
Stewart
Scott R
SR
Miller
William C
WC
Behets
Frieda
F
Dow
William H
WH
Martinson
Francis E A
FE
Chilongozi
David
D
Cohen
Myron S
MS
D000328:Adult; D000818:Animals; D003153:Community Health Services / Q000191:economics; D003362:Cost-Benefit Analysis; D018562:Disease Transmission, Infectious; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008795:Metronidazole / Q000494:pharmacology; D011314:Preventive Health Services / Q000191:economics*; D011897:Random Allocation; D012749:Sexually Transmitted Diseases / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D014245:Trichomonas Infections / Q000188:drug therapy / Q000191:economics*; D014246:Trichomonas vaginalis / Q000187:drug effects
D008795:Metronidazole