TY - JOUR
T1 - Beyond syndromic management
T2 - Opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries
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
AU - Mindel, Adrian
N1 - Funding Information:
This study was funded by a United States – South African Program for Collaborative Biomedical Research grant through the South African Medical Research Council and the National Institute of Health (AI116759). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank Nontobeko Ngubane, Mandisa Msomi, Siphesihle Gumede, Hlengiwe Shozi and the CAPRISA 083 study team for collecting clinical data and specimen. We also thank Jessica Naidoo, Renaldo Noble and Keenan Govender for conducting the POC STI tests and Ntuthu Dla-mini and the eThekwini Municipality clinic team for their expertise and collaboration. We are grateful to all CAPRISA 083 study participants for their contributions to this research.
Publisher Copyright:
© 2018 Garrett et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2018/4
Y1 - 2018/4
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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U2 - 10.1371/journal.pone.0196209
DO - 10.1371/journal.pone.0196209
M3 - Article
C2 - 29689080
AN - SCOPUS:85045958392
SN - 1932-6203
VL - 13
JO - PloS one
JF - PloS one
IS - 4
M1 - e0196209
ER -