1
|
Jiang W, Ronen K, Osborn L, Drake AL, Unger JA, Matemo D, Enquobahrie DA, Kinuthia J, John-Stewart G. Predictors of adverse pregnancy outcomes among Kenyan women with HIV on antiretroviral treatment in pregnancy. AIDS 2022; 36:1007-1019. [PMID: 35652673 PMCID: PMC9178912 DOI: 10.1097/qad.0000000000003215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to understand predictors of adverse pregnancy outcomes (APOs) among women on antiretroviral treatment (ART). DESIGN A longitudinal cohort. METHODS Participants from the Mobile WAChX trial were evaluated for APOs, including stillbirth (fetal death at ≥20 weeks' gestation), preterm birth (PTB, livebirth at <37 weeks' gestation,) and neonatal death (NND, ≤28 days after live birth). Predictors were determined by univariable and multivariable Cox proportional hazards and log-binomial models. RESULTS Among 774 women included, median age was 27 years and 29.0% had unsuppressed HIV viral load (>1000 copies/ml) at enrollment. Half (55.1%) started ART prepregnancy, 89.1% on tenofovir-based regimens. Women with depression had a higher risk of stillbirth (adjusted hazard ratio [aHR] 2.93, 95% confidence interval (95% CI) 1.04-8.23), and women with lower social support score had higher risk of late stillbirth (aHR 11.74, 2.47-55.86). Among 740 livebirths, 201 (27.2%) were preterm and 22 (3.0%) experienced NND. PTB was associated with unsuppressed maternal viral load (adjusted prevalence ratio [aPR] 1.28, 95% CI 1.02-1.61), intimate partner violence (IPV) in pregnancy (aPR 1.94, 95% CI 1.28-2.94), and history of any sexually transmitted infection (STI) (aPR 1.63, 95% CI 1.06-2.51). NND was associated with PTB (aPR 2.53, 95% CI 1.10-5.78) and STI history (aPR 4.25, 95% CI 1.39-13.06). Most associations retained significance in the subgroup of women with viral suppression. CONCLUSION Maternal viremia during pregnancy predicted PTB as did IPV, lower education, and STI history, while psychosocial stressors predicted stillbirth. Implementing mental health services, ART adherence, partner support, and routine STI screening and treatment could reduce APOs among women with HIV in sub-Saharan Africa settings.
Collapse
Affiliation(s)
- Wenwen Jiang
- University of Washington, Seattle, Washington, USA
| | - Keshet Ronen
- University of Washington, Seattle, Washington, USA
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Weaknesses in primary health care favor the growth of acquired syphilis. PLoS Negl Trop Dis 2021; 15:e0009085. [PMID: 33544722 PMCID: PMC7891733 DOI: 10.1371/journal.pntd.0009085] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 02/18/2021] [Accepted: 12/22/2020] [Indexed: 11/23/2022] Open
Abstract
Acquired syphilis is a sexually transmitted infection that affects the general population and has been growing in recent years in many countries. A study was developed aiming to analyze the trends of acquired syphilis associated with sociodemographic aspects and primary health care in Brazil, in the period from 2011 to 2019. This study used secondary data from the national notification systems of the 5570 Brazilian cities and a database of 37,350 primary health care teams, as well as socioeconomic and municipal demographic indicators. The trends of acquired syphilis at the municipal level were calculated from the log-linear regression, crossing them with variables of primary health care and sociodemographic indicators. Finally, a multiple model was built from logistic regression. 724,310 cases of acquired syphilis have been reported. In primary care units, 47.8% had partial coverage and 74.1% had health teams with poor or regular scores. 52.6% had rapid test for syphilis partially available. Male and female condoms are available in 85.9% and 62.9% respectively and 54.4% had penicillin available in the health facility. The increase in trends of acquired syphilis was associated with better availability of the rapid test; lower availability of male condoms; lower availability of female condoms; lower availability of benzathine penicillin; partial coverage of the teams in primary health care; limited application of penicillin in primary health care; higher proportion of teams classified as Poor/Regular in primary health care; higher proportion of women aged 10 to 17 years who had children; higher HDI; higher proportion of people aged 15 to 24 years who do not study, do not work and are vulnerable; and population size with more than 100,000 inhabitants. The following variables remained in the multiple model: not all primary health care teams apply penicillin; higher proportion of primary health care teams with poor/regular scores; population size >100000 inhabitants; partially available female condom. Thus, the weakness of primary health care linked to population size may have favored the growth of the acquired syphilis epidemic in Brazilian cities. Acquired syphilis is a sexually transmitted infection that continues to impact health services around the world. For decades, studies and public health policies in the fight against syphilis have focused on syphilis in pregnant women and congenital, mainly because of their importance in the health of women and children. However, the behavior of the epidemic in people aged over 13 years shows that the epidemic is comprehensive and challenging. The exponential increase in the syphilis epidemic in the general population is one of the most neglected in many parts of the world. Primary health care plays a fundamental role in the control of syphilis, but few studies have sought to analyze the impact of primary health care on the growth of acquired syphilis. Our work used two large databases of the national notification systems of the 5570 Brazilian cities and a database of 37,350 primary health care teams, as well as municipal sociodemographic indicators. Our results demonstrated several indicators that influence the growth of acquired syphilis, especially the most neglected, which can guide more effective strategies to fight the syphilis epidemic in several countries.
Collapse
|
3
|
Marques dos Santos M, Lopes AKB, Roncalli AG, de Lima KC. Trends of syphilis in Brazil: A growth portrait of the treponemic epidemic. PLoS One 2020; 15:e0231029. [PMID: 32271807 PMCID: PMC7145144 DOI: 10.1371/journal.pone.0231029] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/15/2020] [Indexed: 11/18/2022] Open
Abstract
Syphilis is a chronic infectious disease with its prevalence being described since the 15th century. Although its etiological agent and also the treatment measures are widely known, syphilis is still a great public health problem worldwide, mainly in countries with limited resources associated to low investments in health primary care. The aim of the present study was to analyze the trend and regional distribution of syphilis in Brazil between 2007 and 2017. This is an ecological study using secondary data from the Brazilian notification system. The Ministry of Health selected 100 municipalities which presented the worse outcomes related to syphilis from the 5,570 Brazilian municipalities as a target for a comprehensive project in order to tackle the prevalence of syphilis, called the "No Syphilis Project". These priority municipalities represent 57.7% of syphilis cases and about one third of the Brazilian population. They were compared with other 189 non-priority municipalities with more than 100 thousand inhabitants among the Brazilian regions (North, Northeast, Southeast, South and Center-West). Polynomial regression methods and Joinpoint analyses were used to analyze the trend, from which the Annual Average Percent Change (AACP) for each time period was calculated. There was a significant growth trend in all regions for the main three forms of syphilis (in pregnancy, congenital and acquired), especially in the South. The ratio between syphilis in pregnancy and congenital syphilis increased in both priority (AAPC: 8.54%; p<0.001) and non-priority municipalities (AAPC: 2.61%; p = 0.005), as well as in the regions, except the Center-West. High growth trends in syphilis prevalence were found in all municipalities, as well as all five regions between 2007 and 2017, showing that the challenge to reduce or even eliminate syphilis in Brazil is still difficult.
Collapse
Affiliation(s)
- Marquiony Marques dos Santos
- Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Programa de pós-graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Doutorado em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- * E-mail:
| | - Ana Karla Bezerra Lopes
- Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Programa de pós-graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Doutorado em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Laboratório de Microbiologia, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Angelo Giuseppe Roncalli
- Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Programa de pós-graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Kenio Costa de Lima
- Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Programa de pós-graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Programa de pós-graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| |
Collapse
|
4
|
Hersh AR, Megli CJ, Caughey AB. Repeat Screening for Syphilis in the Third Trimester of Pregnancy: A Cost-Effectiveness Analysis. Obstet Gynecol 2019; 132:699-707. [PMID: 30095767 DOI: 10.1097/aog.0000000000002795] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of screening all women during the first and third trimesters compared with screening just once during pregnancy. METHODS We used a theoretical cohort of 3.9 million women in the United States to model syphilis screening approaches in pregnancy, particularly comparing one-time screening with repeat third-trimester screening. Outcomes of syphilis infection included in the model were congenital syphilis, intrauterine fetal demise, neonatal death, and total quality-adjusted life-years (QALYs). Probabilities, utilities, and costs were obtained from the literature, and a cost-effectiveness threshold was set at $100,000 per QALY. A societal perspective was assumed. RESULTS Our model demonstrated that repeat screening in the third trimester for syphilis in pregnancy will result in fewer maternal and neonatal adverse outcomes and higher QALYs when compared with screening once in the first trimester. Specifically, we demonstrated that repeat screening results in 41 fewer neonates with evidence of congenital syphilis, 73 fewer cases of intrauterine fetal demise, 27 fewer neonatal and infant deaths, in addition to a cost savings of $52 million and 4,000 additional QALYs. CONCLUSION Using our baseline assumptions, our data support that in pregnancy, repeat screening for syphilis is superior to single screening during the first trimester and is both cost-effective and results in improvement in maternal and neonatal outcomes. When screening policies are being created for pregnant women, the cost-effectiveness of repeat screening for syphilis should be considered.
Collapse
Affiliation(s)
- Alyssa R Hersh
- Oregon Health & Science University, Portland, Oregon; and the University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | |
Collapse
|
5
|
Pereira LE, McCormick J, Dorji T, Kang J, Sun Y, Shukla M, Hopkins A, Deutsch J, Kersh EN, Bernstein K, Fakile YF. Laboratory Evaluation of a Commercially Available Rapid Syphilis Test. J Clin Microbiol 2018; 56:e00832-18. [PMID: 30021825 PMCID: PMC6156315 DOI: 10.1128/jcm.00832-18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/15/2018] [Indexed: 11/20/2022] Open
Abstract
Serological diagnosis of syphilis depends on assays that detect treponemal and nontreponemal antibodies. Laboratory certification and trained personnel are needed to perform most of these tests, while high costs and long turnaround time can hinder treatment initiation or linkage to care. A rapid treponemal syphilis test (RST) that is simple to perform, accessible, and inexpensive would be ideal. The Syphilis Health Check (SHC) assay is the only Food and Drug Administration (FDA)-cleared and Clinical Laboratory Improvement Amendments (CLIA)-waived RST in the United States. In this study, 1,406 archived human serum samples were tested using SHC and traditional treponemal and nontreponemal assays. Rapid test results were compared with treponemal data alone and with a laboratory test panel consensus defined as being reactive by both treponemal and nontreponemal assays for a given specimen, or nonreactive by both types of assays. The sensitivity and specificity of the SHC assay compared with treponemal tests alone were 88.7% (95% confidence interval [CI], 86.2 to 90.0%) and 93.1% (95% CI, 90.0 to 94.9%), respectively, while comparison with the laboratory test panel consensus showed 95.7% (95% CI, 93.6 to 97.2%) sensitivity and 93.2% (95% CI, 91.0 to 95.1%) specificity. The data were further stratified based on age, sex, pregnancy, and HIV status. The sensitivity and specificity of the SHC assay ranged from 66.7% (95% CI, 46.0 to 83.5%) to 91.7% (95% CI, 87.7 to 94.7%) and 88% (95% CI, 68.8 to 97.5%) to 100% (95% CI, 47.8 to 100%), respectively, across groups compared to traditional treponemal assays, generally increasing for all groups except the HIV-positive (HIV+) population when factoring in the laboratory test panel consensus. These data contribute to current knowledge of the SHC assay performance for distinct populations and may guide use in various settings.
Collapse
Affiliation(s)
- Lara E Pereira
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joshua McCormick
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Tandin Dorji
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joseph Kang
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yongcheng Sun
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mayur Shukla
- Atlanta Research and Education Foundation, Inc., Decatur, Georgia, USA
| | - Andre Hopkins
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John Deutsch
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Ellen N Kersh
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kyle Bernstein
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yetunde F Fakile
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
6
|
Amaya-Guio J, Grillo-Ardila CF, Angel-Müller E, Torres-Montañez NA, Vasquez-Velez LF. Point of care rapid test for diagnosis of syphilis infection in pregnant women. Hippokratia 2018. [DOI: 10.1002/14651858.cd013037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jairo Amaya-Guio
- Faculty of Medicine, Universidad Nacional de Colombia; Department of Obstetrics and Gynecology; Bogota Colombia
| | - Carlos F Grillo-Ardila
- Faculty of Medicine, Universidad Nacional de Colombia; Department of Obstetrics and Gynecology; Bogota Colombia
| | - Edith Angel-Müller
- Faculty of Medicine, Universidad Nacional de Colombia; Department of Obstetrics and Gynecology; Bogota Colombia
| | - Nicolas A Torres-Montañez
- Faculty of Medicine, Universidad Nacional de Colombia; Department of Obstetrics and Gynecology; Bogota Colombia
| | - Luisa F Vasquez-Velez
- Faculty of Medicine, Universidad Nacional de Colombia; Department of Obstetrics and Gynecology; Bogota Colombia
| |
Collapse
|
7
|
Ong JJ, Fu H, Smith MK, Tucker JD. Expanding syphilis testing: a scoping review of syphilis testing interventions among key populations. Expert Rev Anti Infect Ther 2018; 16:423-432. [PMID: 29633888 PMCID: PMC6046060 DOI: 10.1080/14787210.2018.1463846] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Syphilis is an important sexually transmitted infection (STI). Despite inexpensive and effective treatment, few key populations receive syphilis testing. Innovative strategies are needed to increase syphilis testing among key populations. Areas covered: This scoping review focused on strategies to increase syphilis testing in key populations (men who have sex with men (MSM), sex workers, people who use drugs, transgender people, and incarcerated individuals). Expert commentary: We identified many promising syphilis testing strategies, particularly among MSM. These innovations are separated into diagnostic, clinic-based, and non-clinic based strategies. In terms of diagnostics, self-testing, dried blood spots, and point-of-care testing can decentralize syphilis testing. Effective syphilis self-testing pilots suggest the need for further attention and research. In terms of clinic-based strategies, modifying default clinical procedures can nudge physicians to more frequently recommend syphilis testing. In terms of non-clinic based strategies, venue-based screening (e.g. in correctional facilities, drug rehabilitation centres) and mobile testing units have been successfully implemented in a variety of settings. Integration of syphilis with HIV testing may facilitate implementation in settings where individuals have increased sexual risk. There is a strong need for further syphilis testing research and programs.
Collapse
Affiliation(s)
- Jason J. Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Central Clinical School, Monash University, Victoria, Australia
| | - Hongyun Fu
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Eastern Virginia Medical School, Norfolk, USA
| | - M. Kumi Smith
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- University of North Carolina at Chapel Hill, North Carolina, USA
| | - Joseph D. Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- University of North Carolina at Chapel Hill, North Carolina, USA
| |
Collapse
|
8
|
Phang Romero Casas C, Martyn-St James M, Hamilton J, Marinho DS, Castro R, Harnan S. Rapid diagnostic test for antenatal syphilis screening in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open 2018; 8:e018132. [PMID: 29467132 PMCID: PMC5855314 DOI: 10.1136/bmjopen-2017-018132] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To undertake a systematic review and meta-analysis to evaluate the test performance including sensitivity and specificity of rapid immunochromatographic syphilis (ICS) point-of-care (POC) tests at antenatal clinics compared with reference standard tests (non-treponemal (TP) and TP tests) for active syphilis in pregnant women. METHODS Five electronic databases were searched (PubMed, EMBASE, CRD, Cochrane Library and LILACS) to March 2016 for diagnostic accuracy studies of ICS test and standard reference tests for syphilis in pregnant women. Methodological quality was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). A bivariate meta-analysis was undertaken to generate pooled estimates of diagnostic parameters. Results were presented using a coupled forest plot of sensitivity and specificity and a scatter plot. RESULTS The methodological quality of the five included studies with regards to risk of bias and applicability concern judgements was either low or unclear. One study was judged as high risk of bias for patient selection due to exclusion of pregnant women with a previous history of syphilis, and one study was judged at high risk of bias for study flow and timing as not all patients were included in the analysis. Five studies contributed to the meta-analysis, providing a pooled sensitivity and specificity for ICS of 0.85 (95% CrI: 0.73 to 0.92) and 0.98 (95% CrI: 0.95 to 0.99), respectively. CONCLUSIONS This review and meta-analysis observed that rapid ICS POC tests have a high sensitivity and specificity when performed in pregnant women at antenatal clinics. However, the methodological quality of the existing evidence base should be taken into consideration when interpreting these results. PROSPERO REGISTRATION NUMBER CRD42016036335.
Collapse
Affiliation(s)
- Carmen Phang Romero Casas
- Centro de Desenvolvimento Tecnológico em Saúde (CDTS), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute for Science and Technology on Innovation on Diseases of Neglected Populations (INCT/IDPN), National Council for Scientific and Technological Development (CNPq), Brazil
| | | | - Jean Hamilton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Daniel S Marinho
- Centro de Desenvolvimento Tecnológico em Saúde (CDTS), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute for Science and Technology on Innovation on Diseases of Neglected Populations (INCT/IDPN), National Council for Scientific and Technological Development (CNPq), Brazil
| | - Rodolfo Castro
- National Institute for Science and Technology on Innovation on Diseases of Neglected Populations (INCT/IDPN), National Council for Scientific and Technological Development (CNPq), Brazil
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Instituto de Saúde Coletiva, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Sue Harnan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| |
Collapse
|
9
|
Gliddon HD, Peeling RW, Kamb ML, Toskin I, Wi TE, Taylor MM. A systematic review and meta-analysis of studies evaluating the performance and operational characteristics of dual point-of-care tests for HIV and syphilis. Sex Transm Infect 2017; 93:S3-S15. [PMID: 28747410 PMCID: PMC6754342 DOI: 10.1136/sextrans-2016-053069] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/07/2017] [Accepted: 04/29/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Mother-to-child transmission (MTCT) of syphilis and HIV continue to be important yet preventable causes of perinatal and infant morbidity and mortality. OBJECTIVES To systematically review, critically appraise and perform a meta-analysis to evaluate the operational characteristics of dual rapid diagnostic tests (RDTs) for HIV/syphilis and evaluate whether they are cost effective, acceptable and easy to use. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched seven electronic bibliographic databases from 2012 to December 2016 with no language restrictions. Search keywords included HIV, syphilis and diagnosis. REVIEW METHODS We included studies that evaluated the operational characteristics of dual HIV/syphilis RDTs. Outcomes included diagnostic test accuracy, cost effectiveness, ease of use and interpretation and acceptability. All studies were assessed against quality criteria and assessed for risk of bias. RESULTS Of 1914 identified papers, 18 were included for the meta-analysis of diagnostic accuracy for HIV and syphilis. All diagnostic accuracy evaluation studies showed a very high sensitivity and specificity for HIV and a lower, yet adequate, sensitivity and specificity for syphilis, with some variation among types of test. Dual screening for HIV and syphilis was more cost effective than single rapid tests for HIV and syphilis and prevented more adverse pregnancy outcomes. Qualitative data suggested dual RDTs were highly acceptable to clients, who cited time to result, cost and the requirement of a single finger prick as important characteristics of dual RDTs. CONCLUSION The results of this systematic review and meta-analysis can be used by policy-makers and national programme managers who are considering implementing dual RDTs for HIV and syphilis. TRIAL REGISTRATION NUMBER PROSPERO 2016:CRD42016049168.
Collapse
Affiliation(s)
- Harriet D Gliddon
- London Centre for Nanotechnology, University College London, London, UK
| | - Rosanna W Peeling
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Mary L Kamb
- Division of STD Prevention, Center for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Teodora E Wi
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Melanie M Taylor
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| |
Collapse
|
10
|
Benzaken AS, Sabidó M, Brito I, Bermúdez XPD, Benzaken NS, Galbán E, Peeling RW, Mabey D. HIV and syphilis in the context of community vulnerability among indigenous people in the Brazilian Amazon. Int J Equity Health 2017; 16:92. [PMID: 28583173 PMCID: PMC5460420 DOI: 10.1186/s12939-017-0589-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 05/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contextual factors shape the risk of acquiring human immunodeficiency virus (HIV) and syphilis. We estimated the prevalence of both infections among indigenous people in nine indigenous health districts of the Brazilian Amazon and examined the context of community vulnerability to acquiring these infections. METHODS We trained 509 health care workers to screen sexually active populations in the community for syphilis and HIV using rapid testing (RT). We then assessed the prevalence of HIV and syphilis using RT. A multivariable analysis was used to identify factors associated with syphilis infection (sociodemographic, condom use, intrusion, population mobility, and violence). RESULTS Of the 45,967 indigenous people tested, the mean age was 22.5 years (standard deviation: 9.2), and 56.5% were female. Overall, for HIV, the prevalence was 0.13% (57/43,221), and for syphilis, the prevalence was 1.82% (745/40,934). The prevalence in men, women, and pregnant women for HIV was 0.16%, 0.11%, and 0.07%, respectively, and for syphilis, it was 2.23%, 1.51%, and 1.52%, respectively. The district Vale do Javari had the highest prevalence of both infections (HIV: 3.38%, syphilis: 1.39%). This district also had the highest population mobility and intrusion and the lowest availability of prenatal services. Syphilis infection was independently associated with age (odds ratio [OR] 1.04, 95% confidence interval [CI]: 1.03-1.05), male sex (OR 1.32, 95% CI: 1.14-1.52), and mobility (moderate: OR: 7.46, 95% CI: 2.69-20.67; high: OR 7.09, 95% CI: 3.79-13.26). CONCLUSIONS The large-scale integration of RT in remote areas increased case detection among pregnant women, especially for syphilis, in districts with higher vulnerability. Mobility is an important risk factor, especially in districts with higher vulnerability. Contextually appropriate approaches that address this factor could contribute to the long-term success of HIV and syphilis control programs.
Collapse
Affiliation(s)
- Adele Schwartz Benzaken
- Department of STI, AIDS and Viral Hepatitis, Secretary for Health Surveillance, Ministry of Health Brazil, Brasília, DF, Brazil.,Tropical Medicine Foundation Doctor Heitor Vierira Dourado, Manaus, Brazil
| | - Meritxell Sabidó
- Department of STI, AIDS and Viral Hepatitis, Secretary for Health Surveillance, Ministry of Health Brazil, Brasília, DF, Brazil. .,Pan American Health Organization, Brasília, Brazil. .,TransLab. Department of Medical Sciences, Universitat de Girona, Catalonia, Spain. .,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Ivo Brito
- Department of STI, AIDS and Viral Hepatitis, Secretary for Health Surveillance, Ministry of Health Brazil, Brasília, DF, Brazil
| | - Ximena Pamela Díaz Bermúdez
- Pan American Health Organization, Brasília, Brazil.,Departamento de Saúde Coletiva, Universidade de Brasília, Brasília, Brazil
| | | | | | - Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - David Mabey
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|