title: Costing of National STI Program Implementation for the Global STI Control Strategy for the Health Sector, 2016-2021.
abstract: BACKGROUND
  In 2016 the World Health Assembly adopted the global strategy on Sexually Transmitted Infections (STI) 2016-2021 aiming to reduce curable STIs by 90% by 2030. We costed scaling-up priority interventions to coverage targets.
  
  
  METHODS
  Strategy-targeted declines in Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Trichomonas vaginalis were applied to WHO-estimated regional burdens at 2012. Syndromic case management was costed for these curable STIs, symptomatic Herpes Simplex Virus 2 (HSV-2), and non-STI vaginal syndromes, with incrementally expanding etiologic diagnosis. Service unit costs were multiplied with clinic attendances and people targeted for screening or prevention, by income tier. Human papilloma virus (HPV) vaccination and screening were costed for coverage increasing to 60% of 10-year-old girls for vaccination, and 60% of women 30-49 years for twice-lifetime screening (including clinical follow-up for positive screens), by 2021.
  
  
  RESULTS
  Strategy implementation will cost an estimated US$ 18.1 billion over 2016-2021 in 117 low- and middle-income countries. Cost drivers are HPV vaccination ($3.26 billion) and screening ($3.69 billion), adolescent chlamydia screening ($2.54 billion), and antenatal syphilis screening ($1.4 billion). Clinical management-of 18 million genital ulcers, 29-39 million urethral discharges and 42-53 million vaginal discharges annually-will cost $3.0 billion, including $818 million for service delivery and $1.4 billion for gonorrhea and chlamydia testing. Global costs increase from $2.6 billion to $ 4.0 billion over 2016-2021, driven by HPV services scale-up, despite vaccine price reduction. Sub-Saharan Africa, bearing 40% of curable STI burdens, covers 44% of global service needs and 30% of cost, the Western Pacific 15% of burden/need and 26% of cost, South-East Asia 20% of burden/need and 18% of cost.
  
  
  CONCLUSIONS
  Costs of global STI control depend on price trends for HPV vaccines and chlamydia tests. Middle-income and especially low-income countries need increased investment, innovative financing, and synergizing with other health programs.
authors.affiliation: Avenir Health, Geneva, Switzerland / Glastonbury, Connecticut, United States of America.
authors.forename: Eline L
authors.initials: EL
authors.lastname: Korenromp
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Teodora
authors.initials: T
authors.lastname: Wi
authors.affiliation: Harvard University School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Stephen
authors.initials: S
authors.lastname: Resch
authors.affiliation: Avenir Health, Geneva, Switzerland / Glastonbury, Connecticut, United States of America.
authors.forename: John
authors.initials: J
authors.lastname: Stover
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Nathalie
authors.identifier: http://orcid.org/0000-0002-3665-4861
authors.initials: N
authors.lastname: Broutet
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis / Q000191:economics / Q000382:microbiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification* / Q000472:pathogenicity; D003362:Cost-Benefit Analysis / Q000191:economics*; D005260:Female; D018258:Herpesvirus 2, Human / Q000472:pathogenicity; D006801:Humans; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000472:pathogenicity; D027383:Papillomaviridae / Q000472:pathogenicity; D053918:Papillomavirus Vaccines / Q000191:economics* / Q000627:therapeutic use; D012749:Sexually Transmitted Diseases / Q000191:economics* / Q000453:epidemiology / Q000382:microbiology; D014210:Treponema pallidum / Q000472:pathogenicity; D014246:Trichomonas vaginalis / Q000472:pathogenicity
chemical_list: D053918:Papillomavirus Vaccines