Assessment of the routine, occupation-based gonorrhea and syphilis screening program in Moscow, Russia: an analysis of sexually transmitted infection prevalence and cost-effectiveness.
OBJECTIVE
In the Russian Federation, large sectors of the population regularly undergo mandatory occupational screening for sexually transmitted infections (STIs). Objectives of our study were to determine the prevalence of syphilis and gonorrhea in the screened occupational groups in Moscow and to conduct a cost-effectiveness evaluation of the occupational screening program.


METHODS
Serum samples from 4 main occupational groups (food handlers and other food industry workers, market salespersons, education and health care providers, and hotel and other public utility workers) were tested for syphilis and gonorrhea. We conducted a cost-effectiveness analysis (in 2003 rubles) of the screening program using decision analysis models.


RESULTS
In the total sample of 1000 study participants, overall prevalence for syphilis was 1.2% with the highest rate in market salespersons (4.4%) and for gonorrhea 0.3%. The incremental cost per case of STI treated was 8409 rubles ($252) for syphilis screening (compared with no screening) with higher incremental costs associated with expanding the program to include gonorrhea screening. The relatively low STI prevalence in the screened groups and the poor performance of the diagnostic tests used were important factors in the estimated cost-effectiveness of occupation-based screening.


CONCLUSIONS
Modifications to occupation-based screening, including an increased focus on higher risk population and the adoption of more current diagnostic technologies, could help to use prevention resources more effectively.
Kourbatova
Ekaterina V
EV
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Akovbyan
Vagan A
VA
Chesson
Harrell W
HW
Lytkina
Irina N
IN
Dmitriev
Georgyi A
GA
Tikhonova
Lilia I
LI
Koubanova
Anna A
AA
Petukhova
Irina I
II
Latypova
Munira F
MF
Aboymova
Olga A
OA
Lewis
Joel S
JS
Ryan
Caroline A
CA
Shakarishvili
Anna
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000379:methods / Q000592:standards; D005260:Female; D006069:Gonorrhea / Q000097:blood / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D009786:Occupational Health Services / Q000191:economics; D009790:Occupations / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D015995:Prevalence; D012426:Russia / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000097:blood / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D014504:Urban Health