Effectiveness and cost-benefit of enhancements to a syphilis screening andtreatment program at a county jail

Background: High rates of syphilis are found in inmates of county jails. Tr eatment of this infected transient population necessitated the development of a rapid protocol. Goal: To evaluate a rapid screening and treatment protocol for syphilis in a county jail. Study Design: Over a 2-year period 18,442 inmates were screened for syphili s with a nontreponemal test and record search for treatment history. Confir matory test results were reviewed following treatment, Cost was defined as deflated marginal outlays, Benefit was calculated as the discounted expecte d cost of treatment of congenital, late, and neurosyphilis. Results: The sensitivity, specificity, and positive predictive value of the protocol were 99.6%, 80.8%, and 79.3%, respectively. Of 257 confirmed case s, 183 were offered treatment in jail. The percentage of short-term inmates treated increased following implementation. The cost-benefit ratio was 9.1 4:1, Conclusions: The protocol was highly effective in patient identification an d treatment delivery. and cost-effective as well.