RESUMO
OBJECTIVE: The objective of this study was to compare the costs of antenatal syphilis screening with the rapid plasma reagin (RPR) test and the immunochromatographic strip (ICS) test in low-resource settings. GOAL: The goal of this study was to assess the costs of introducing rapid syphilis tests to reduce maternal and congenital syphilis. STUDY DESIGN: Cost data were collected from participating study hospitals and antenatal clinics during 4 field visits to the 2 countries in 2003 and 2004. Health utilization outcome data on the number of women screened and treated routinely during the demonstration projects were used with unit cost data to estimate the incremental costs and average cost per woman screened and treated for maternal syphilis. RESULTS: In Mozambique, the average cost per woman screened was U.S. $0.91 and U.S. $1.05 for the RPR and ICS tests, respectively. In Bolivia, the average cost of screening was U.S. $1.48 and U.S. $1.91 using the RPR and ICS test, respectively. In health centers without laboratories, the cost per woman screened using the ICS test ranged from U.S. $1.02 in Mozambique to U.S. $2.84 in Bolivia. CONCLUSIONS: It is feasible to introduce rapid syphilis testing in settings without laboratory services at a small incremental cost per woman screened. In settings with laboratories, the cost of ICS is similar to that of RPR.
Assuntos
Complicações Infecciosas na Gravidez/diagnóstico , Diagnóstico Pré-Natal/economia , Diagnóstico Pré-Natal/estatística & dados numéricos , Sífilis/diagnóstico , Instituições de Assistência Ambulatorial , Bolívia/epidemiologia , Cromatografia/economia , Cromatografia/métodos , Custos e Análise de Custo , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitais , Humanos , Imunoensaio/economia , Imunoensaio/métodos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Moçambique/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Kit de Reagentes para Diagnóstico/economia , Kit de Reagentes para Diagnóstico/estatística & dados numéricos , Reaginas/sangue , Sífilis/epidemiologia , Sífilis/prevenção & controle , Sífilis/transmissão , Sífilis Congênita/prevenção & controleRESUMO
OBJECTIVE: To identify necessary components of a successful cystic fibrosis (CF) newborn screening (NBS) program. STUDY DESIGN: The approach to CF NBS used by the Massachusetts NBS program was examined. RESULTS: Several key components were identified that should be addressed when a state has made the decision to screen, and well in advance of actual implementation. These components include (1) inclusion of CF center directors in the development process; (2) logistics of choosing a screening algorithm relative to practices in place and community wishes; (3) projections of medical service needs from specific algorithms; (4) identification of critical reporting components; (5) identification of critical follow-up components; and (6) recognition of educational needs. CONCLUSIONS: Careful examination of a wide variety of issues is needed to ensure optimal implementation of NBS for CF.
Assuntos
Fibrose Cística/diagnóstico , Avaliação das Necessidades/organização & administração , Triagem Neonatal/organização & administração , Desenvolvimento de Programas/métodos , Assistência ao Convalescente/organização & administração , Algoritmos , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Tomada de Decisões Gerenciais , Aconselhamento Genético/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Recém-Nascido , Massachusetts , Modelos Organizacionais , Triagem Neonatal/psicologia , Avaliação de Resultados em Cuidados de Saúde/organização & administração , Pais/educação , Pais/psicologia , Diretores Médicos/educação , Diretores Médicos/organização & administração , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde/métodos , Sensibilidade e Especificidade , Apoio SocialRESUMO
OBJECTIVE: To evaluate compliance with recommendations for sweat testing/specialty evaluation and genetic counseling after a positive cystic fibrosis newborn screening (CF NBS) result. STUDY DESIGN: All infants with positive CF NBS results require a diagnostic sweat test at a CF center. Results that were "screen positive and diagnosis negative" prompted family genetic counseling. Parent compliance with follow-up protocol recommendations was retrospectively analyzed relative to the communications model in place at a particular CF Center. RESULTS: At each of the 5 MA CF centers, 95% of the CF NBS-positive infants completed recommended sweat testing. In contrast, there was wide disparity in compliance (32%-90%) with completion of genetic counseling between CF centers. CONCLUSION: CF centers that escorted parents through the 2 recommended follow-up steps in 1 day had higher compliance with the second step (genetic counseling) than centers that required a return visit for genetic counseling.