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In Madagascar, the prevalence of sexually transmitted infections (STIs) is a serious public health problem, particularly among sex workers. A Horizons study conducted in 2000 found approximately two-thirds of female sex workers had an STI, although few were infected with HIV. Since the link between STIs and transmission of HIV has been well established, affordable strategies to manage STIs among sex workers need to be developed. Study investigators also assessed STI management practices in health facilities in two urban areas of Madagascar. Health practitioners were using a syndromic approach, which may be appropriate for managing certain STIs in the general population but is less appropriate for sex workers who may have multiple, often asymptomatic infections. Diagnosing STIs with laboratory tests would make medical visits prohibitively expensive. Researchers developed a risk profile for various STIs based on characteristics of women that present with each STI, such as age, number of partners, symptoms. The investigators hypothesized that a risk assessment tool using these profiles would result in more appropriate and effective STI treatment for sex workers. This summary presents a cost-effectiveness analysis of different strategies to manage STIs among sex workers in Madagascar.






Horizons Program