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Reducing the burden of sexually transmitted infections in resource-limited settings: the role of improved diagnostics

There is a great need for improved diagnosis of curable bacterial sexually transmitted infections among women in developing countries. We found that wider access to new diagnostic tests has a greater overall impact on health outcomes than improvements in test sensitivity or specificity.

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Figure 1: Antenatal syphilis decision trees.
Figure 2: Decision trees for gonorrhoea and chlamydia.
Figure 3
Figure 4: Impact of a 10% change in a given input parameter on adjusted lives saved for two different hypothetical antenatal syphilis screening tests compared with the status quo laboratory-based rapid plasma reagin (RPR) test.
Figure 5: Impact of a 10% change in a given input parameter on adjusted disability-adjusted life years (DALYs) saved for two different hypothetical gonorrhoea and chlamydia diagnostic tests compared with the status quo diagnostic strategies.
Figure 6

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Acknowledgements

The authors thank B. Schackman (Weill Medical College of Cornell University, New York, USA) and G. Garnett (Imperial College London, UK) for helpful comments on earlier drafts. In addition, we thank F. Terris-Prestholt (London School of Hygiene and Tropical Medicine, UK) and P. Mwaba (University of Zambia, School of Medicine, Lusaka Zambia) for contributions to the analysis and K. Leuschner (RAND Corporation, Santa Monica, California, USA) for assistance in drafting the manuscript.

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Aledort, J., Ronald, A., Rafael, M. et al. Reducing the burden of sexually transmitted infections in resource-limited settings: the role of improved diagnostics. Nature 444 (Suppl 1), 59–72 (2006). https://doi.org/10.1038/nature05447

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