{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T05:42:43Z","timestamp":1792215763578,"version":"4.4.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Uganda National Institute of Public Health","award":["INV-059606"],"award-info":[{"award-number":["INV-059606"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Vulvovaginal candidiasis (VVC) is commonly managed syndromically or investigated using fungal culture. This study compared direct medical costs of 3 diagnostic pathways for acute VVC in Uganda.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A decision-analytic cost model compared syndromic management, culture-based diagnosis, and microscopy-based diagnosis in a hypothetical cohort of 1000 symptomatic women. The proportion classified by the microscopy-based framework as meeting the model criteria for antifungal treatment (10.1%) was derived from 447 high vaginal swab records at Sebbi Hospital (2022\u20132025). Laboratory and antifungal costs were obtained from procurement records and Uganda Joint Medical Stores prices. The culture-based pathway incorporated a return-visit consultation fee. One-way sensitivity analyses were conducted, and a societal-perspective scenario used to assess cost differences between pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Total direct costs per 1000 women were US dollar (USD) 10 761 for syndromic management, USD 35 565 for culture-based diagnosis, and USD 14 996 for microscopy-based diagnosis. Culture-based diagnosis was the costliest pathway under every condition examined, exceeding microscopy-based diagnosis by USD 20 568 and syndromic management by USD 24 804. Microscopy-based diagnosis did not generate net savings over syndromic management at base-case public-sector antifungal prices. The cost difference was most sensitive to the unit cost of microscopy and antifungal treatment. Selective fungal culture increased the cost of the microscopy-based pathway in a separate scenario analysis. For the base-case microscopy-based pathway, without selective fungal culture, the break-even antifungal unit price was USD 6.01 per treatment episode.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Under the modeled assumptions, microscopy-based diagnosis becomes less costly than syndromic management when the antifungal treatment price exceeded the base-case break-even threshold.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag624","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:39:54Z","timestamp":1790681994000},"source":"Crossref","is-referenced-by-count":0,"title":["Direct Cost Analysis of Diagnostic Pathways for Acute Vulvovaginal Candidiasis in Uganda: A Modeling Study"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9719-3934","authenticated-orcid":false,"given":"Jonani","family":"Bwambale","sequence":"first","affiliation":[{"name":"Uganda National Institute of Public Health (UNIPH), Ministry of Health , Kampala ,","place":["Uganda"]},{"name":"Clinical Laboratory, Sebbi Hospital , Nansana Municipality, Wakiso District ,","place":["Uganda"]},{"name":"Karis Medical Clinic , Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nakitende Patricia","family":"Peace","sequence":"additional","affiliation":[{"name":"Clinical Laboratory, Sebbi Hospital , Nansana Municipality, Wakiso District ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ssebunya","family":"Enock","sequence":"additional","affiliation":[{"name":"Karis Medical Clinic , Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8445-9414","authenticated-orcid":false,"given":"Gerald","family":"Mboowa","sequence":"additional","affiliation":[{"name":"The African Centre of Excellence in Bioinformatics and Data-Intensive Sciences, Infectious Diseases Institute, Makerere University , Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Kisakye","sequence":"additional","affiliation":[{"name":"Uganda National Institute of Public Health (UNIPH), Ministry of Health , Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9690-4650","authenticated-orcid":false,"given":"Abel W","family":"Walekhwa","sequence":"additional","affiliation":[{"name":"IDEMU Mathematical Modelling Unit, Department of Epidemiology and Biostatistics, Makerere University School of Public Health , Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Ocom","sequence":"additional","affiliation":[{"name":"Uganda National Institute of Public Health (UNIPH), Ministry of Health , Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex R","family":"Ario","sequence":"additional","affiliation":[{"name":"Uganda National Institute of Public Health (UNIPH), Ministry of Health , Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betty Kivumbi","family":"Nannyonga","sequence":"additional","affiliation":[{"name":"Department of Mathematics, School of Physical Sciences, College of Natural Sciences, Makerere University , Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"2026101701120737400_ofag624-B1","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1093\/cid\/ciaf673","article-title":"State-of-the-art review: managing vulvovaginal candidiasis","volume":"82","author":"Rautemaa-Richardson","year":"2026","journal-title":"Clin Infect Dis"},{"key":"2026101701120737400_ofag624-B2","doi-asserted-by":"crossref","first-page":"100680","DOI":"10.1016\/j.ijregi.2025.100680","article-title":"Economic burden of recurrent vulvovaginal candidiasis in Uganda: a cost-of-illness analysis","volume":"16","author":"Jonani","year":"2025","journal-title":"IJID Reg"},{"key":"2026101701120737400_ofag624-B3","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1186\/s12879-023-08442-2","article-title":"Evaluation and optimization of the syndromic management of female genital tract infections in Nairobi, 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vulvovaginal disease vaginal wet mount microscopy guidelines: how to perform, applications, and interpretation","volume":"25","author":"Vieira-Baptista","year":"2021","journal-title":"J Low Genit Tract Dis"},{"key":"2026101701120737400_ofag624-B11","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1177\/0956462420943034","article-title":"British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis (2019)","volume":"31","author":"Saxon Lead Author Guideline Development Group Cara","year":"2020","journal-title":"Int J STD AIDS"},{"key":"2026101701120737400_ofag624-B12","doi-asserted-by":"crossref","first-page":"60","DOI":"10.3390\/jof4020060","article-title":"Adhesins in Candida glabrata","volume":"4","author":"Timmermans","year":"2018","journal-title":"J Fungi (Basel)"},{"key":"2026101701120737400_ofag624-B13","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1186\/s12916-021-02094-2","article-title":"Patient and health 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