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8 Web Appendix Table. Expected adverse pregnancy outcomes resulting from the cohort decision model comparing each HIV and syphilis testing algorithm for a theoretical cohort of 100,000 pregnant women in Malawi Screening Strategy Total Still Birth Prematurity/ Congenital Neonatal Adverse or Fetal Low Birth HIV MTCT Syphilis Death pregnancy Loss Weight outcomes HIV rapid test screening only 186 4,852 3,112 6,370 1,300 15,820 HIV rapid test & laboratory-based for syphilis 174 4,836 3,105 6,365 1,299 15,779 Single rapid tests for HIV & syphilis 174 4,836 3,104 6,365 1,299 15,778 Dual HIV and syphilis test 51 4,669 3,031 6,319 1,300 15,370
9 Web references w1. Montoya PJ, Lukehart SA, Brentlinger PE, et al. Comparison of the diagnostic accuracy of a rapid immunochromatographic test and the rapid plasma reagin test for antenatal syphilis screening in Mozambique. Bulletin of the World Health Organization 2006;84(2): w2. Nessa K, Alam A, Chawdhury FA, et al. Field evaluation of simple rapid tests in the diagnosis of syphilis. International journal of STD & AIDS 2008;19(5): w3. Malawi Ministry of Health. Malawi National Plan for the Elimination of Mother to Child Transmission. In: ed., w4. Ministry of Health. MANAGEMENT OF SEXUALLY TRANSMITTED INFECTIONS USING SYNDROMIC MANAGEMENT APPROACH: Guidelines for Service Providers Third Edition V1. ed_protect/---protrav/---ilo_aids/documents/legaldocument/wcms_ pdf, w5. CHOosing Interventions that are Cost Effective (WHO_CHOICE). Secondary CHOosing Interventions that are Cost Effective (WHO_CHOICE) w6. GDP Deflator. Secondary GDP Deflator Available at:
10 w7. Weinstein MC, Siegel JE, Gold MR, et al. Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA 1996;276(15): W8. Garnett GP, Aral SO, Hoyle DV, et al. The natural history of syphilis. Implications for the transmission dynamics and control of infection. Sexually transmitted diseases 1997;24(4): w9. Malawi Ministry of Health. Integrated HIV program report July - September 2013: Government of Malawi Ministry of Health, w10. Kagulire SC, Opendi P, Stamper PD, et al. Field evaluation of five rapid diagnostic tests for screening of HIV-1 infections in rural Rakai, Uganda. International journal of STD & AIDS 2011;22(6): w11. Kahn JG, Jiwani A, Gomez GB, et al. The cost and cost-effectiveness of scaling up screening and treatment of syphilis in pregnancy: a model. PloS one 2014;9(1):e w12. Kuznik A, Lamorde M, Nyabigambo A, et al. Antenatal syphilis screening using point-of-care testing in Sub-Saharan African countries: a cost-effectiveness analysis. PLoS medicine 2013;10(11):e w13. Owusu-Edusei K, Jr., Tao G, Gift TL, et al. Cost-effectiveness of integrated routine offering of prenatal HIV and syphilis screening in China. Sexually transmitted diseases 2014;41(2):
11 w14. Rydzak CE, Goldie SJ. Cost-effectiveness of rapid point-of-care prenatal syphilis screening in sub-saharan Africa. Sexually transmitted diseases 2008;35(9): w15. Terris-Prestholt F, Vickerman P, Torres-Rueda S, et al. The cost-effectiveness of 10 antenatal syphilis screening and treatment approaches in Peru, Tanzania, and Zambia. Int J Gynaecol Obstet w16. Owusu-Edusei K, Jr., Gift TL, Ballard RC. Cost-effectiveness of a dual non-treponemal/treponemal syphilis point-of-care test to prevent adverse pregnancy outcomes in sub-saharan Africa. Sexually transmitted diseases 2011;38(11): w17. Tuite AR, Burchell AN, Fisman DN. Cost-effectiveness of enhanced syphilis screening among HIV-positive men who have sex with men: a microsimulation model. PloS one 2014;9(7):e w18. National Statistical Office and UNICEF. Malawi Multiple Indicator Cluster Survey 2006, Final Report. Lilongwe, Malawi, Accessed 3 December Available at: w19. Myer L, Wilkinson D, Lombard C, et al. Impact of on-site testing for maternal syphilis on treatment delays, treatment rates, and perinatal mortality in rural South Africa: a randomised controlled trial. Sexually transmitted infections 2003;79(3):
12 w20. Tenthani L, Haas AD, Tweya H, et al. Retention in care under universal antiretroviral therapy for HIV-infected pregnant and breastfeeding women ('Option B+') in Malawi. Aids 2014;28(4): w21. Kesho Bora Study G, de Vincenzi I. Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial. The Lancet infectious diseases 2011;11(3): w22. Ciaranello AL, Perez F, Engelsmann B, et al. Cost-effectiveness of World Health Organization 2010 Guidelines for Prevention of Mother-to-Child Transmission in Zimbabwe. Clinical Infectious Diseases. 2013;56(3): w23. Fasawe O, Avila C, Shaffer N, et al. Cost-effectiveness analysis of Option B+ for HIV prevention and treatment of mothers and children in Malawi. PloS one 2013;8(3):e w24. Orlando S, Marazzi MC, Mancinelli S, et al. Cost-effectiveness of using HAART in prevention of mother-to-child transmission in the DREAM-Project Malawi. Journal of acquired immune deficiency syndromes 2010;55(5): w25. Global Health Observatory of the World Health Organization. World Health Organization Life Tables - Malawi. Data extracted 18 March w26. Drummond M, Schulpher MJ, Torrance G, et al. Methods for the economic evaluation of health care programmes. 3rd ed. Oxford ; New York: Oxford University Press, 2005.
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