title: The costs of accessible quality assured syphilis diagnostics: informing quality systems for rapid syphilis tests in a Tanzanian setting.
abstract: OBJECTIVE
  To determine the costs of Rapid Syphilis Test (RSTs) as compared with rapid plasma reagin (RPR) when implemented in a Tanzanian setting, and to determine the relative impact of a quality assurance (QA) system on the cost of RST implementation.
  
  
  METHODS
  The incremental costs for RPR and RST screening programmes in existing antenatal care settings in Geita District, Tanzania were collected for 9 months in subsequent years from nine health facilities that varied in size, remoteness and scope of antenatal services. The costs per woman tested and treated were estimated for each facility. A sensitivity analysis was constructed to determine the impact of parameter and model uncertainty.
  
  
  RESULTS
  In surveyed facilities, a total of 6362 women were tested with RSTs compared with 224 tested with RPR. The range of unit costs was $1.76-$3.13 per woman screened and $12.88-$32.67 per woman treated. Unit costs for the QA system came to $0.51 per woman tested, of which 50% were attributed to salaries and transport for project personnel.
  
  
  CONCLUSIONS
  Our results suggest that rapid syphilis diagnostics are very inexpensive in this setting and can overcome some critical barriers to ensuring universal access to syphilis testing and treatment. The additional costs for implementation of a quality system were found to be relatively small, and could be reduced through alterations to the programme design. Given the potential for a quality system to improve quality of diagnosis and care, we recommend that QA activities be incorporated into RST roll-out.
authors.affiliation: London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, National Institute for Medical Research, Mwanza Tanzania and London School of Hygiene and Tropical Medicine, Keppel Street, WCIE 7HT, London sedona.sweeney@lshtm.ac.uk.
authors.forename: Sedona
authors.initials: S
authors.lastname: Sweeney
authors.affiliation: London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, National Institute for Medical Research, Mwanza Tanzania and London School of Hygiene and Tropical Medicine, Keppel Street, WCIE 7HT, London.
authors.forename: Jacklin F
authors.initials: JF
authors.lastname: Mosha
authors.affiliation: London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, National Institute for Medical Research, Mwanza Tanzania and London School of Hygiene and Tropical Medicine, Keppel Street, WCIE 7HT, London.
authors.forename: Fern
authors.initials: F
authors.lastname: Terris-Prestholt
authors.affiliation: London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, National Institute for Medical Research, Mwanza Tanzania and London School of Hygiene and Tropical Medicine, Keppel Street, WCIE 7HT, London.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Sollis
authors.affiliation: London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, National Institute for Medical Research, Mwanza Tanzania and London School of Hygiene and Tropical Medicine, Keppel Street, WCIE 7HT, London.
authors.forename: Helen
authors.initials: H
authors.lastname: Kelly
authors.affiliation: London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, National Institute for Medical Research, Mwanza Tanzania and London School of Hygiene and Tropical Medicine, Keppel Street, WCIE 7HT, London.
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.affiliation: London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, National Institute for Medical Research, Mwanza Tanzania and London School of Hygiene and Tropical Medicine, Keppel Street, WCIE 7HT, London.
authors.forename: Rosanna W
authors.initials: RW
authors.lastname: Peeling
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs; D005260:Female; D006801:Humans; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D011295:Prenatal Care / Q000191:economics / Q000379:methods; D011785:Quality Assurance, Health Care / Q000191:economics; D012680:Sensitivity and Specificity; D013587:Syphilis / Q000175:diagnosis*; D013588:Syphilis Serodiagnosis / Q000191:economics*; D013636:Tanzania
keywords: Diagnosis; economic evaluation; maternal and child health; quality control; sexually transmitted infections