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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 Abdool Karim; Ayesha B. M. Kharsany; Koleka P. Mlisana; Anne Rompalo; Adrian Mindel

Title:
Beyond syndromic management: Opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries
Author(s):
Garrett, Nigel J.
Osman, Farzana
Maharaj, Bhavna
Naicker, Nivashnee
Gibbs, Andrew
Norman, Emily
Samsunder, Natasha
Ngobese, Hope
Mitchev, Nireshni
Singh, Ravesh
Abdool Karim, Salim
Kharsany, Ayesha B. M.
Mlisana, Koleka P.
Rompalo, Anne
Mindel, Adrian
Date:
Type:
Articles
Department(s):
Epidemiology
Volume:
13
Persistent URL:
Book/Journal Title:
PLoS ONE
Geographic Area:
South Africa
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.
Subject(s):
Sexual health
Sexually transmitted diseases--Treatment
Epidemiology
HIV infections—Prevention
Publisher DOI:
https://doi.org/10.1371/journal.pone.0196209
Item views
24
Metadata:
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Suggested Citation:
Nigel J. Garrett, Farzana Osman, Bhavna Maharaj, Nivashnee Naicker, Andrew Gibbs, Emily Norman, Natasha Samsunder, Hope Ngobese, Nireshni Mitchev, Ravesh Singh, Salim Abdool Karim, Ayesha B. M. Kharsany, Koleka P. Mlisana, Anne Rompalo, Adrian Mindel, , Beyond syndromic management: Opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries, Columbia University Academic Commons, .

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