Beyond syndromic management: Opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries

Nigel J. Garrett, Farzana Osman, Bhavna Maharaj, Nivashnee Naicker, Andrew Gibbs, Emily Norman, Natasha Samsunder, Hope Ngobese, Nireshni Mitchev, Ravesh Singh, Salim S. Abdool Karim, Ayesha B.M. Kharsany, Koleka Mlisana, Anne Marie Rompalo, Adrian Mindel

Research output: Contribution to journalArticle

Abstract

Introduction In light of the limited impact the syndromic management approach has had on the global sexually transmitted infection (STI) epidemic, we assessed a care model comprising point-of-care (POC) STI testing, immediate treatment, and expedited partner therapy (EPT) among a cohort of young women at high HIV risk in South Africa. Methods and findings HIV negative women presenting for STI care underwent POC testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV), and swabs were sent for NG culture and susceptibility testing. Results were available within 2 hours and women with STIs were immediately treated and offered EPT packs, including medication, condoms, and information for sexual partners. An EPT questionnaire was administered after one week, and women retested for STIs after 6 and 12 weeks. 267 women, median age 23 (IQR 21–26), were recruited and 88.4% (236/267) reported genital symptoms. STI prevalence was CT 18.4% (95%CI 13.7–23.0), NG 5.2% (95%CI 2.6–7.9) and TV 3.0% (95%CI 1.0–5.0). After 12 weeks, all but one NG and two CT infections were cleared. No cephalosporin-resistant NG was detected. Of 63/267 women (23.6%) diagnosed with STIs, 98.4% (62/ 63) were offered and 87.1% (54/62) accepted EPT. At one week 88.9% (48/54) stated that their partner had taken the medication. No allergic reactions or social harms were reported. Of 51 women completing 6-week follow up, detection rates were lower amongst women receiving EPT (2.2%, 1/46) compared to those who did not (40.0%, 2/5), p = 0.023. During focus group discussions women supported the care model, because they received a rapid, specific diagnosis, and could facilitate their partners’ treatment. Conclusions POC STI testing and EPT were acceptable to young South African women and their partners, and could play an important role in reducing STI reinfection rates and HIV risk. Larger studies should evaluate the feasibility and cost-effectiveness of implementing this strategy at population level.

Original languageEnglish (US)
Article numbere0196209
JournalPLoS One
Volume13
Issue number4
DOIs
StatePublished - Apr 1 2018

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sexually transmitted diseases
Sexually Transmitted Diseases
income
Neisseria gonorrhoeae
Testing
Chlamydia trachomatis
therapeutics
Point-of-Care Systems
Trichomonas vaginalis
Cephalosporins
Therapeutics
Cost effectiveness
HIV
drug therapy
testing
cephalosporins
Chlamydia Infections
focus groups
Sexual Partners
Condoms

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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Beyond syndromic management : Opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries. / Garrett, Nigel J.; Osman, Farzana; Maharaj, Bhavna; Naicker, Nivashnee; Gibbs, Andrew; Norman, Emily; Samsunder, Natasha; Ngobese, Hope; Mitchev, Nireshni; Singh, Ravesh; Abdool Karim, Salim S.; Kharsany, Ayesha B.M.; Mlisana, Koleka; Rompalo, Anne Marie; Mindel, Adrian.

In: PLoS One, Vol. 13, No. 4, e0196209, 01.04.2018.

Research output: Contribution to journalArticle

Garrett, NJ, Osman, F, Maharaj, B, Naicker, N, Gibbs, A, Norman, E, Samsunder, N, Ngobese, H, Mitchev, N, Singh, R, Abdool Karim, SS, Kharsany, ABM, Mlisana, K, Rompalo, AM & Mindel, A 2018, 'Beyond syndromic management: Opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries', PLoS One, vol. 13, no. 4, e0196209. https://doi.org/10.1371/journal.pone.0196209
Garrett, Nigel J. ; Osman, Farzana ; Maharaj, Bhavna ; Naicker, Nivashnee ; Gibbs, Andrew ; Norman, Emily ; Samsunder, Natasha ; Ngobese, Hope ; Mitchev, Nireshni ; Singh, Ravesh ; Abdool Karim, Salim S. ; Kharsany, Ayesha B.M. ; Mlisana, Koleka ; Rompalo, Anne Marie ; Mindel, Adrian. / Beyond syndromic management : Opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries. In: PLoS One. 2018 ; Vol. 13, No. 4.
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abstract = "Introduction In light of the limited impact the syndromic management approach has had on the global sexually transmitted infection (STI) epidemic, we assessed a care model comprising point-of-care (POC) STI testing, immediate treatment, and expedited partner therapy (EPT) among a cohort of young women at high HIV risk in South Africa. Methods and findings HIV negative women presenting for STI care underwent POC testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV), and swabs were sent for NG culture and susceptibility testing. Results were available within 2 hours and women with STIs were immediately treated and offered EPT packs, including medication, condoms, and information for sexual partners. An EPT questionnaire was administered after one week, and women retested for STIs after 6 and 12 weeks. 267 women, median age 23 (IQR 21–26), were recruited and 88.4{\%} (236/267) reported genital symptoms. STI prevalence was CT 18.4{\%} (95{\%}CI 13.7–23.0), NG 5.2{\%} (95{\%}CI 2.6–7.9) and TV 3.0{\%} (95{\%}CI 1.0–5.0). After 12 weeks, all but one NG and two CT infections were cleared. No cephalosporin-resistant NG was detected. Of 63/267 women (23.6{\%}) diagnosed with STIs, 98.4{\%} (62/ 63) were offered and 87.1{\%} (54/62) accepted EPT. At one week 88.9{\%} (48/54) stated that their partner had taken the medication. No allergic reactions or social harms were reported. Of 51 women completing 6-week follow up, detection rates were lower amongst women receiving EPT (2.2{\%}, 1/46) compared to those who did not (40.0{\%}, 2/5), p = 0.023. During focus group discussions women supported the care model, because they received a rapid, specific diagnosis, and could facilitate their partners’ treatment. Conclusions POC STI testing and EPT were acceptable to young South African women and their partners, and could play an important role in reducing STI reinfection rates and HIV risk. Larger studies should evaluate the feasibility and cost-effectiveness of implementing this strategy at population level.",
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AU - Garrett, Nigel J.

AU - Osman, Farzana

AU - Maharaj, Bhavna

AU - Naicker, Nivashnee

AU - Gibbs, Andrew

AU - Norman, Emily

AU - Samsunder, Natasha

AU - Ngobese, Hope

AU - Mitchev, Nireshni

AU - Singh, Ravesh

AU - Abdool Karim, Salim S.

AU - Kharsany, Ayesha B.M.

AU - Mlisana, Koleka

AU - Rompalo, Anne Marie

AU - Mindel, Adrian

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N2 - Introduction In light of the limited impact the syndromic management approach has had on the global sexually transmitted infection (STI) epidemic, we assessed a care model comprising point-of-care (POC) STI testing, immediate treatment, and expedited partner therapy (EPT) among a cohort of young women at high HIV risk in South Africa. Methods and findings HIV negative women presenting for STI care underwent POC testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV), and swabs were sent for NG culture and susceptibility testing. Results were available within 2 hours and women with STIs were immediately treated and offered EPT packs, including medication, condoms, and information for sexual partners. An EPT questionnaire was administered after one week, and women retested for STIs after 6 and 12 weeks. 267 women, median age 23 (IQR 21–26), were recruited and 88.4% (236/267) reported genital symptoms. STI prevalence was CT 18.4% (95%CI 13.7–23.0), NG 5.2% (95%CI 2.6–7.9) and TV 3.0% (95%CI 1.0–5.0). After 12 weeks, all but one NG and two CT infections were cleared. No cephalosporin-resistant NG was detected. Of 63/267 women (23.6%) diagnosed with STIs, 98.4% (62/ 63) were offered and 87.1% (54/62) accepted EPT. At one week 88.9% (48/54) stated that their partner had taken the medication. No allergic reactions or social harms were reported. Of 51 women completing 6-week follow up, detection rates were lower amongst women receiving EPT (2.2%, 1/46) compared to those who did not (40.0%, 2/5), p = 0.023. During focus group discussions women supported the care model, because they received a rapid, specific diagnosis, and could facilitate their partners’ treatment. Conclusions POC STI testing and EPT were acceptable to young South African women and their partners, and could play an important role in reducing STI reinfection rates and HIV risk. Larger studies should evaluate the feasibility and cost-effectiveness of implementing this strategy at population level.

AB - Introduction In light of the limited impact the syndromic management approach has had on the global sexually transmitted infection (STI) epidemic, we assessed a care model comprising point-of-care (POC) STI testing, immediate treatment, and expedited partner therapy (EPT) among a cohort of young women at high HIV risk in South Africa. Methods and findings HIV negative women presenting for STI care underwent POC testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV), and swabs were sent for NG culture and susceptibility testing. Results were available within 2 hours and women with STIs were immediately treated and offered EPT packs, including medication, condoms, and information for sexual partners. An EPT questionnaire was administered after one week, and women retested for STIs after 6 and 12 weeks. 267 women, median age 23 (IQR 21–26), were recruited and 88.4% (236/267) reported genital symptoms. STI prevalence was CT 18.4% (95%CI 13.7–23.0), NG 5.2% (95%CI 2.6–7.9) and TV 3.0% (95%CI 1.0–5.0). After 12 weeks, all but one NG and two CT infections were cleared. No cephalosporin-resistant NG was detected. Of 63/267 women (23.6%) diagnosed with STIs, 98.4% (62/ 63) were offered and 87.1% (54/62) accepted EPT. At one week 88.9% (48/54) stated that their partner had taken the medication. No allergic reactions or social harms were reported. Of 51 women completing 6-week follow up, detection rates were lower amongst women receiving EPT (2.2%, 1/46) compared to those who did not (40.0%, 2/5), p = 0.023. During focus group discussions women supported the care model, because they received a rapid, specific diagnosis, and could facilitate their partners’ treatment. Conclusions POC STI testing and EPT were acceptable to young South African women and their partners, and could play an important role in reducing STI reinfection rates and HIV risk. Larger studies should evaluate the feasibility and cost-effectiveness of implementing this strategy at population level.

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