Academic Journal
Estimating the Value of Novel Tests for Active Syphilis in Zimbabwe: How Much Overtreatment Can Be Avoided?
| Τίτλος: | Estimating the Value of Novel Tests for Active Syphilis in Zimbabwe: How Much Overtreatment Can Be Avoided? |
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| Συγγραφείς: | Stuart RM; Burnet Institute, Melbourne, Australia., Marks M; Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine.; Hospital for Tropical Diseases, University College London Hospital.; Division of Infection and Immunity, University College London., Chikwari CD; MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.; Biomedical Research and Training Institute, Harare, Zimbabwe., Muellenmeister AM; Burnet Institute, Melbourne, Australia., Abeysuriya RG; Burnet Institute, Melbourne, Australia., Manguro G; Burnet Institute, Melbourne, Australia., Peters RPH; Department for HIV, TB, Hepatitis and Sexually Transmitted Infections, World Health Organization, Geneva, Switzerland., Rao DW; Burnet Institute, Melbourne, Australia., Newman LM; Burnet Institute, Melbourne, Australia. |
| Πηγή: | Sexually transmitted diseases [Sex Transm Dis] 2026 Aug 01; Vol. 53 (8), pp. 500-509. Date of Electronic Publication: 2026 May 15. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: J B Lippincott Country of Publication: United States NLM ID: 7705941 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1537-4521 (Electronic) Linking ISSN: 01485717 NLM ISO Abbreviation: Sex Transm Dis Subsets: MEDLINE |
| Imprint Name(s): | Publication: Philadelphia Pa : J B Lippincott Original Publication: Philadelphia, Lippincott. |
| Ιατρικοί όροι (MeSH): | Syphilis*/diagnosis , Syphilis*/drug therapy , Syphilis*/epidemiology , Syphilis*/economics , Overtreatment*/economics , Overtreatment*/statistics & numerical data , Point-of-Care Testing*/economics, Zimbabwe/epidemiology ; Treponema pallidum/isolation & purification ; Treponema pallidum/genetics ; HIV Infections/diagnosis ; HIV Infections/epidemiology ; Humans ; Female ; Cost-Benefit Analysis ; Male ; Syphilis Serodiagnosis ; Rapid Diagnostic Tests ; Adult ; Mass Screening |
| Περίληψη: | Background: Syphilis diagnosis in resource-limited settings relies on syndromic management and treponemal-based antibody screening tests that cannot distinguish active infection from past-treated infection, both of which can lead to overtreatment. Point-of-care (POC) tests that detect active infection could reduce unnecessary treatment. Methods: We developed an agent-based model of co-transmitting syphilis and human immunodeficiency virus, calibrated to Zimbabwe using population-based survey data (ZIMPHIA) and UNAIDS estimates. We modeled five scenarios involving two hypothetical new POC diagnostic products introduced from 2027: (1) a test detecting Treponema pallidum DNA in genital ulcer specimens, and (2) a non-treponemal test identifying active infection following a treponemal-positive result, applied across antenatal care, key population, and human immunodeficiency virus care settings. We also conducted a threshold-based cost analysis to assess whether reductions in unnecessary treatment alone could be cost-saving. Results: Under the current standard of care, approximately 112,000 adult syphilis treatments are administered annually across all modeled detection and screening use cases, of which approximately 80% are unnecessary (i.e., administered to individuals who do not have an active syphilis infection). Combining both diagnostics reduces overtreatment to 24% (a 3.4-fold reduction). Across use cases, each test avoids approximately 0.4 to 0.8 unnecessary treatments, implying cost savings whenever the test price is less than 40% to 80% of the treatment cost. Conclusions: Even under the conservative assumption that current syndromic management and screening practices achieve high syphilis treatment rates among care-seeking individuals, introducing POC diagnostics for active syphilis could substantially reduce overtreatment while maintaining treatment of individuals with active infection. Reductions in unnecessary treatment alone may be cost-saving at low test prices, even without accounting for downstream health outcomes. This analysis does not model the impact of improved diagnostics on transmission dynamics, congenital syphilis burden, or other health outcomes; studies that quantify these additional benefits are needed to inform a full economic evaluation. (Copyright © 2026 American Sexually Transmitted Diseases Association. All rights reserved.) |
| Competing Interests: | Conflict of Interest and Sources of Funding: None declared. |
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| Entry Date(s): | Date Created: 20260701 Date Completed: 20260701 Latest Revision: 20260813 |
| Update Code: | 20260814 |
| PubMed Central ID: | PMC13326924 |
| DOI: | 10.1097/OLQ.0000000000002348 |
| PMID: | 42383905 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1537-4521 |
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| DOI: | 10.1097/OLQ.0000000000002348 |