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Auchus IC, Kama M, Bhuiyan RAK, Brown J, Dean D. Chlamydial and gonorrheal neglected sexually transmitted diseases among Pacific Islanders of the Western Pacific Region-A narrative review and call to action. PLoS Negl Trop Dis 2023; 17:e0011171. [PMID: 36928890 PMCID: PMC10019716 DOI: 10.1371/journal.pntd.0011171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
The Pacific Island countries of the Western Pacific Region have some of the highest rates of sexually transmitted Chlamydia trachomatis and Neisseria gonorrhoeae infections in the world. Despite this, there are few research studies that include Pacific Islanders. We conducted a narrative review of original research and surveys, including World Health Organization and Pacific Community reports, to determine the prevalence, management, and treatment of C. trachomatis and N. gonorrhoeae compared to HIV and syphilis from 1980 to 2022. Available epidemiologic data on C. trachomatis and N. gonorrhoeae indicated an extremely high prevalence-approximately 30% and 13%, respectively-among Pacific Islanders during this timeframe. These neglected sexually transmitted infections represent a significant burden and health disparity. Robust epidemiologic research is needed to identify modifiable risk factors for designing interventions and control strategies. Appropriate policies along with regional and international advocacy and aid are required to improve reproductive health among these vulnerable, understudied populations to avert preventable infections and sequelae.
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Affiliation(s)
- Isabella Catherine Auchus
- Department of Medicine and Pediatrics, University of California San Francisco School of Medicine, San Francisco, California, United States of America
| | - Mike Kama
- Ministry of Health and Medical Services, Suva, Fiji
| | | | - Joelle Brown
- Department of Medicine and Pediatrics, University of California San Francisco School of Medicine, San Francisco, California, United States of America
- Bixby Center for Global Reproductive Health, University of California San Francisco, San Francisco, California, United States of America
- Global Health Sciences Institute, University of California San Francisco, San Francisco, California, United States of America
| | - Deborah Dean
- Department of Medicine and Pediatrics, University of California San Francisco School of Medicine, San Francisco, California, United States of America
- Bixby Center for Global Reproductive Health, University of California San Francisco, San Francisco, California, United States of America
- Global Health Sciences Institute, University of California San Francisco, San Francisco, California, United States of America
- Benioff Center for Microbiome Medicine, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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Barriers and enablers to young people accessing sexual and reproductive health services in Pacific Island Countries and Territories: A scoping review. PLoS One 2023; 18:e0280667. [PMID: 36701390 PMCID: PMC9879431 DOI: 10.1371/journal.pone.0280667] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 01/05/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The number of young people utilising sexual and reproductive health services in Pacific Island Countries and Territories remains poor despite the availability and the existence of the fundamental rights to access these services. Adolescents and youth need accurate information and timely access to contraceptives to prevent adverse consequences associated with unintended pregnancies, abortion, childbirth and untreated sexually transmitted infections. This scoping review identifies and analyses factors contributing to young people's low access to sexual and reproductive health information and services in this region. METHODS Guided by the PRISMA Scoping review guidelines, we searched three databases (Medline Ovid, Scopus and CINAHL Complete) for peer-reviewed articles published between 1st January 2000 and 31st August 2020 that reported on factors, including barriers and enablers, affecting access to sexual and reproductive health information and services by young people living in Pacific Island Countries and Territories. We assessed the quality of each study according to the study designs, methods of data collection, data analysis and ethical considerations. All information was sorted and organised using an Excel Spreadsheet. Text data from published articles were charted inductively using thematic analysis with no predetermined codes and themes. FINDINGS Five hundred eighty-nine articles were screened, and only eight met the inclusion criteria outlined in this scoping review protocol. These eight articles reported studies conducted in four Pacific Island Countries and Territories: Cook Islands, Fiji, Papua New Guinea, and Vanuatu. Factors such as lack of accurate sexual and reproductive health knowledge and social stigma were the leading causes of young people's limited access to sexual and reproductive health services. Cultural and religious beliefs also invoked stigmatising behaviours in some family and community members. CONCLUSION This scoping review revealed that social stigma and judgemental attitudes imposed by family and community members, including healthcare providers, hinder young unmarried individuals in Pacific Island Countries and Territories from accessing sexual and reproductive health information and contraceptives. Alternatively, a non-judgmental healthcare provider is perceived as an enabler in accessing sexual and reproductive health information and services. Moreover, given that only a few studies have actually focused on young people's sexual and reproductive health needs in the region, more research is required to fully understand the health-seeking behaviours of young people in their specific contexts.
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Blanco P, Rachline A, Tarantola A, Biron A, Pereyre S, Coutherut J, Patoureau M. Prevalence of Mycoplasma genitalium and other sexually transmitted pathogens in male urethritis in a sexual health centre in New Caledonia. Int J STD AIDS 2022; 33:792-798. [PMID: 35621120 DOI: 10.1177/09564624221103808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence of sexually transmitted infections (STIs) is high in New Caledonia (NC), but there are no data on Mycoplasma genitalium (MG). However, the syndromic treatment of urethritis used in the territory includes a single dose of azithromycin, which could generate resistance in MG. METHODS We recruited 217 men referred to the Noumea public medical centre (CMP) with signs of urethritis and meeting the inclusion criteria from May 2016 to March 2018. Each was tested for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and for the first time in NC for MG by polymerase chain reaction (PCR). RESULTS The prevalence of MG was 10.1% (22/217). Azithromycin resistance of MG (mutation in the 23S rRNA gene) could only be assessed for 10 of the 22 strains. Only one (1/10; 10%) was resistant. The prevalence of other STIs tested was high, as CT, NG and/or TV were associated in 77.3% (17/22) of MG-positive cases. CONCLUSIONS Although co-infections further justify syndromic management, the presence of MG in NC urethritis cases could call treatment guidelines into question.
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Affiliation(s)
- Patrick Blanco
- Public Medical Center (CMP), DPASS South Province, Nouméa, New Caledonia
| | - Anne Rachline
- Public Medical Center (CMP), DPASS South Province, Nouméa, New Caledonia
| | - Arnaud Tarantola
- Epidemiology Unit, 117080Institut Pasteur in New Caledonia, Nouméa, New Caledonia
| | - Antoine Biron
- Medical Biology Laboratory, 117080Institut Pasteur in New Caledonia, Nouméa, New Caledonia
| | - Sabine Pereyre
- National Reference Center for Bacterial STI, Bacteriology Laboratory, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Julie Coutherut
- Center for Prevention of Infectious and Transmissible Diseases, 26922Nantes University Hospital, Nantes, France
| | - Marion Patoureau
- Public Medical Center (CMP), DPASS South Province, Nouméa, New Caledonia
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Hammou J, Guagliardo SAJ, Obtel M, Razine R, Haroun AE, Youbi M, Bellefquih AM, White M, Gwyn S, Martin DL. Post-Validation Survey in Two Districts of Morocco after the Elimination of Trachoma as a Public Health Problem. Am J Trop Med Hyg 2022; 106:tpmd211140. [PMID: 35344929 PMCID: PMC9128706 DOI: 10.4269/ajtmh.21-1140] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/16/2022] [Indexed: 11/07/2022] Open
Abstract
Trachoma is the leading infectious cause of blindness. In 2016, Morocco was validated by WHO as having eliminated trachoma as a public health problem. We evaluated two previously endemic districts in Morocco for trachomatous inflammation-follicular (TF), trachomatous trichiasis (TT), and antibodies against Chlamydia trachomatis, the causative agent of trachoma. Community-based cross-sectional surveys in the districts of Boumalene Dades and Agdez included 4,445 participants for whom both questionnaire and serology data were available; 58% were aged 1-9 years. Participants had eyes examined for TF and blood collected for analysis of antibodies to the C. trachomatis antigen Pgp3 by both a multiplex bead assay (MBA) and lateral flow assay (LFA). Seroconversion rates (SCR) per 100 people per year were used to estimate changes in the force of infection using Bayesian serocatalytic models. In Agdez, TF prevalence in 1-9-year-olds was 0.3%, seroprevalence ranged from 9.4% to 11.4%, and SCR estimates ranged from 2.4 to 3.0. In Boumalene Dades, TF prevalence in 1-9-year-olds was 0.07%, and modeling data from the different assays indicated a decrease in transmission between 20 and 24 years ago. The TF data support an absence of active trachoma in the two districts examined. However, seroprevalence and SCR in younger people were higher in Agdez than Boumalene Dades, showing that there can be differences in serology metrics in areas with similar TF prevalence. Data will be included in multicountry analyses to better understand potential thresholds for serological surveillance in trachoma.
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Affiliation(s)
- Jaouad Hammou
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Sarah Anne J. Guagliardo
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Majdouline Obtel
- Laboratory of Biostatistics, Clinical Research and Epidemiology, Department of Public Health, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
- Laboratory of Community Heath (Public Health, Preventive Medicine and Hygiene), Department of Public Health, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Rachid Razine
- Laboratory of Biostatistics, Clinical Research and Epidemiology, Department of Public Health, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
- Laboratory of Community Heath (Public Health, Preventive Medicine and Hygiene), Department of Public Health, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Abbas Ermilo Haroun
- Laboratory of Biostatistics, Clinical Research and Epidemiology, Department of Public Health, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
- Laboratory of Community Heath (Public Health, Preventive Medicine and Hygiene), Department of Public Health, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Mohamed Youbi
- Directorate of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | | | - Michael White
- Infectious Disease Epidemiology and Analytics Unit, Department of Global Health, Institute Pasteur, Paris, France
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kaforau LS, Tessema GA, Bugoro H, Pereira G, Jancey J. Lived experiences of women with low birth weight infants in the Solomon Islands: A descriptive qualitative study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001008. [PMID: 36962868 PMCID: PMC10022132 DOI: 10.1371/journal.pgph.0001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022]
Abstract
Every year, around 20 million women worldwide give birth to low birth weight (LBW) infants, with majority of these births occurring in low-and middle-income countries, including the Solomon Islands. Few studies have explored the pregnancy lived experience of women who deliver LBW infants. The aim of the study is to understand the lived experience of women in the Solomon Islands who gave birth to LBW infants by exploring their personal (socio-demographic and health), behavioural, social and environmental contexts. We used a qualitative descriptive approach and purposely selected 18 postnatal women with LBW infants in the Solomon Islands for an in-depth interview. All data were analysed using thematic analysis in NVivo. We identified six themes reported as being related to LBW: health issues, diet and nutrition, substance use, domestic violence, environmental conditions and antenatal care. Our findings suggest that women in the Solomon Islands are exposed to various personal, behavioural, social and environmental risk factors during pregnancy that can impact birth outcomes, particularly LBW. We recommend further research should be redirected to look at the factors/themes identified in the interviews.
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Affiliation(s)
- Lydia S Kaforau
- Curtin School of Population Health, Curtin University, Perth, Australia
- School of Nursing and Allied Health Sciences, Solomon Islands National University, Honiara, Solomon Islands
| | - Gizachew A Tessema
- Curtin School of Population Health, Curtin University, Perth, Australia
- School of Public Health, The University of Adelaide, South Australia, Australia
| | - Hugo Bugoro
- School of Nursing and Allied Health Sciences, Solomon Islands National University, Honiara, Solomon Islands
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Australia
| | - Jonine Jancey
- Curtin School of Population Health, Curtin University, Perth, Australia
- enAble Institute, Curtin University, Perth, Australia
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Whelan J, Abbing-Karahagopian V, Serino L, Unemo M. Gonorrhoea: a systematic review of prevalence reporting globally. BMC Infect Dis 2021; 21:1152. [PMID: 34763670 PMCID: PMC8582208 DOI: 10.1186/s12879-021-06381-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends periodic gonorrhoea prevalence assessments in the general population or proxies thereof (including pregnant women, women attending family planning clinics, military recruits, and men undergoing employment physicals for example) and in population groups at increased risk, including men-who-have-sex-with-men (MSM) and sex workers. METHOD We evaluated reported prevalence data, including estimates from proxy general population samples to reflect the WHO recommendations. We describe the outcomes from the general population country-by-country and extend previous reviews to include MSM, sex workers, and extragenital infections. RESULT AND CONCLUSION In our systematic search, 2015 titles were reviewed (January 2010-April 2019) and 174 full-text publications were included. National, population-based prevalence data were identified in only four countries (the United States of America, the United Kingdom, Peru, New Caledonia) and local population-based estimates were reported in areas within five countries (China, South Africa, Brazil, Benin, and Malawi). The remaining studies identified only reported test positivity from non-probability, proxy general population samples. Due to the diversity of the reviewed studies, detailed comparison across studies was not possible. In MSM, data were identified from 64 studies in 25 countries. Rectal infection rates were generally higher than urogenital or pharyngeal infection rates, where extragenital testing was conducted. Data on sex workers were identified from 41 studies in 23 countries; rates in female sex workers were high. Current prevalence monitoring was shown to be highly suboptimal worldwide. Serial prevalence monitoring of critical epidemiological variables, and guidelines to optimize prevalence study conduct and reporting beyond antenatal settings are recommended.
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Affiliation(s)
- Jane Whelan
- Clinical and Epidemiology Research and Development, GSK, Amsterdam, The Netherlands.
| | | | - Laura Serino
- Clinical and Epidemiology Research and Development, GSK, Siena, Italy
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Scoullar MJL, Boeuf P, Peach E, Fidelis R, Tokmun K, Melepia P, Elijah A, Bradshaw CS, Fehler G, Siba PM, Erskine S, Mokany E, Kennedy E, Umbers AJ, Luchters S, Robinson LJ, Wong NC, Vallely AJ, Badman SG, Vallely LM, Fowkes FJI, Morgan C, Pomat W, Crabb BS, Beeson JG. Mycoplasma genitalium and Other Reproductive Tract Infections in Pregnant Women, Papua New Guinea, 2015-2017. Emerg Infect Dis 2021; 27:894-904. [PMID: 33622474 PMCID: PMC7920647 DOI: 10.3201/eid2703.201783] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Much about the range of pathogens, frequency of coinfection, and clinical effects of reproductive tract infections (RTIs) among pregnant women remains unknown. We report on RTIs (Mycoplasma genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Treponema pallidum subspecies pallidum, bacterial vaginosis, and vulvovaginal candidiasis) and other reproductive health indicators in 699 pregnant women in Papua New Guinea during 2015–2017. We found M. genitalium, an emerging pathogen in Papua New Guinea, in 12.5% of participants. These infections showed no evidence of macrolide resistance. In total, 74.1% of pregnant women had >1 RTI; most of these infections were treatable. We detected sexually transmitted infections (excluding syphilis) in 37.7% of women. Our findings showed that syndromic management of infections is greatly inadequate. In total, 98.4% of women had never used barrier contraception. These findings will inform efforts to improve reproductive healthcare in Papua New Guinea.
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Abstract
INTRODUCTION Congenital syphilis remains a significant cause of newborn mortality and long-term neurodevelopmental problems in some low- and middle-income countries. This study was done in Honiara, Solomon Islands to determine the incidence of babies born to mothers with a positive venereal disease research laboratory (VDRL) test and a positive Treponema pallidum haemagglutination assay (TPHA); to determine the VDRL status of newborns and features of congenital syphilis; and to estimate the proportion of stillbirths associated with syphilis. METHODOLOGY All neonates born to VDRL-positive mothers, including stillbirths were included between April and July 2019. Neonates were examined, investigated and treated. RESULTS Among 1534 consecutive births, 1469 were live births and 65 (4.2%) were stillbirths. One hundred and forty-three neonates were born to VDRL-positive mothers: 130 (90.1%) were live infants and 13 (8.9%) stillbirths. Of the 130 VDRL-exposed live-born infants, 72 (55%) had reactive VDRL and a positive TPHA and 7 (9.7%) had clinical signs of congenital syphilis. Five of the infants with clinical signs of syphilis infection had a 4-fold higher VDRL titre than their mother. Four infants of VDRL-positive mothers died during admission, all of whom had clinical signs of syphilis. Ninety percent of affected infants were born to mothers who were not treated or only partially treated during pregnancy. CONCLUSIONS In this study, 1:210 live-born babies had clinical and serological evidence of congenital syphilis, and evidence of Treponema infection was found disproportionately in stillbirths. In a setting where Treponema infections are common, an empirical approach to prevention may be needed.
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Affiliation(s)
- Maxson Lifigao
- Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands
| | - Titus Nasi
- Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands
| | - Carol Titiulu
- Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands
| | - Steven Lumasa
- Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, Parkville, 3052, Australia.,School of Medicine and Health Sciences, University of Papua New Guinea, Taurama, National Capital District, Papua New Guinea
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Martin DL, Saboyà-Díaz MI, Abashawl A, Alemayeh W, Gwyn S, Hooper PJ, Keenan J, Kalua K, Szwarcwald CL, Nash S, Oldenburg C, West SK, White M, Solomon AW. The use of serology for trachoma surveillance: Current status and priorities for future investigation. PLoS Negl Trop Dis 2020; 14:e0008316. [PMID: 32970672 PMCID: PMC7514076 DOI: 10.1371/journal.pntd.0008316] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Diana L Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Martha Idalí Saboyà-Díaz
- Communicable Diseases and Environmental Determinants of Health Department, Pan-American Health Organization, Washington, DC, United States of America
| | - Aida Abashawl
- Berhan Public Health and Eye Care Consultancy, Addis Ababa, Ethiopia
| | - Wondu Alemayeh
- Berhan Public Health and Eye Care Consultancy, Addis Ababa, Ethiopia.,The Fred Hollows Foundation, Addis Ababa, Ethiopia
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Pamela J Hooper
- International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Jeremy Keenan
- Francis I. Proctor Foundation, University of California at San Francisco, San Francisco, California, United States of America.,Department of Ophthalmology, University of California at San Francisco, San Francisco, California, United States of America
| | - Khumbo Kalua
- Department of Ophthalmology, University of Malawi, College of Medicine Blantyre, Malawi
| | - Celia Landmann Szwarcwald
- Institute of Scientific and Technological Communication and information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Scott Nash
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Catherine Oldenburg
- Francis I. Proctor Foundation, University of California at San Francisco, San Francisco, California, United States of America.,Department of Ophthalmology, University of California at San Francisco, San Francisco, California, United States of America.,Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
| | - Sheila K West
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Michael White
- Malaria: Parasites & Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Butcher R, Tagabasoe J, Manemaka J, Bong A, Garae M, Daniel L, Roberts C, Handley BL, Hu VH, Harding-Esch EM, Bakhtiari A, Willis R, Müller A, Kaldor J, Le Mesurier R, Mabey D, Cama A, Sokana O, Taleo F, Taylor HR, Solomon AW. Conjunctival scarring, corneal pannus and Herbert's pits in adolescent children in trachoma-endemic populations of the Solomon Islands and Vanuatu. Clin Infect Dis 2020; 73:e2773-e2780. [PMID: 32776137 PMCID: PMC8563182 DOI: 10.1093/cid/ciaa1151] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Indexed: 11/21/2022] Open
Abstract
Background In the Solomon Islands and Vanuatu, the sign trachomatous inflammation—follicular (TF) is common, but ocular infection with Chlamydia trachomatis is not. It is therefore debatable whether azithromycin mass drug administration (MDA), the recommended antibiotic treatment strategy for trachoma’s elimination as a public health problem, is necessary in this setting. We set out to estimate what proportion of adolescents were at risk of progression of trachomatous scarring. Methods A cross-sectional survey was undertaken of all children aged 10–14 years resident in communities identified as high-TF clusters during previous population-based mapping. Graders examined children for clinical evidence of trachomatous scarring, pannus, and Herbert’s pits (HPs) or limbal follicles in both eyes. A dried blood spot was collected from each child and tested for antibodies to C. trachomatis. Results A total of 492 children in 24 villages of the Solomon Islands and Vanuatu were examined. In total, 35/492 (7%) of children had limbal signs (pannus and/or HPs) plus any conjunctival scarring. And 9/492 (2%) had limbal signs and moderate or severe conjunctival scarring; 22% of children were anti-Pgp3 seropositive. Conclusions Few adolescents here are at risk of future complications from trachoma, supporting the conclusion that further antibiotic MDA is not currently required for trachoma elimination purposes in these settings.
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Affiliation(s)
- Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Junely Tagabasoe
- Eye Department, Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Joseph Manemaka
- Health Promotion Department, Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Annie Bong
- Eye Department, Vanuatu Ministry of Health, Port Vila, Vanuatu
| | - Mackline Garae
- Department of Neglected Tropical Diseases, Vanuatu Ministry of Health, Port Vila, Vanuatu
| | - Lui Daniel
- Eye Department, Vanuatu Ministry of Health, Port Vila, Vanuatu
| | - Chrissy Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Becca L Handley
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Victor H Hu
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Andreas Müller
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia.,Programme for Blindness and Visual Impairment, World Health Organization, Geneva, Switzerland
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - David Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anasaini Cama
- The Fred Hollows Foundation, Carlton, Victoria, Australia
| | - Oliver Sokana
- Eye Department, Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Fasihah Taleo
- Department of Neglected Tropical Diseases, Vanuatu Ministry of Health, Port Vila, Vanuatu.,Country Office, World Health Organization, Port Vila, Vanuatu
| | - Hugh R Taylor
- Indigenous Eye Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Anthony W Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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11
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Ocular Chlamydia trachomatis infection, anti-Pgp3 antibodies and conjunctival scarring in Vanuatu and Tarawa, Kiribati before antibiotic treatment for trachoma. J Infect 2020; 80:454-461. [PMID: 32017971 PMCID: PMC7113835 DOI: 10.1016/j.jinf.2020.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 11/21/2022]
Abstract
In Vanuatu, ocular Chlamydia infection prevalence is low; in Kiribati it is high. In Vanuatu, Pgp3 seroprevalence does not increase in childhood; in Kiribati it does. Conjunctival scarring is more common in adults in Kiribati than in Vanuatu. Trachomatous inflammation—follicular lacks specificity for ocular Chlamydia infection. Non-TF markers may help to determine need for interventions against active trachoma.
Introduction In the peri-elimination setting, the positive predictive value of trachomatous inflammation–follicular (TF), the primary marker used to determine need for antibiotics for trachoma, is suboptimal. Here, three non-TF measures are used to compare two regions where TF prevalence exceeds the threshold for intervention, but where the Chlamydia trachomatis (Ct) prevalence is different. Methods Population prevalence of trachoma was measured in Vanuatu (n = 3470) and Kiribati (n = 2922). Dried blood spots (DBS) and conjunctival photographs were collected from every survey participant, and conjunctival swabs were collected from those aged 1–9 years. Individuals were tested for blood anti-Pgp3 antibodies, Ct DNA at the conjunctiva and severity of conjunctival scarring. Results The prevalence of TF in 1–9-year-olds was 16.5% in Vanuatu and 38.2% in Tarawa. 7% of people aged ≥1 year in Vanuatu had conjunctival scarring compared to 27% in Tarawa. The prevalence of ocular Ct infection in 1–9-year-olds was 1.5% in Vanuatu and 27.4% in Tarawa. The seroconversion rate amongst 1–9-year-old children in Vanuatu and Tarawa was 0.018 and 0.197 events per child per year, respectively. Conclusions Comparing Vanuatu to Tarawa demonstrates several markers that could be used to differentiate the trachoma status of populations in these (and other) locations.
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Rowley J, Vander Hoorn S, Korenromp E, Low N, Unemo M, Abu-Raddad LJ, Chico RM, Smolak A, Newman L, Gottlieb S, Thwin SS, Broutet N, Taylor MM. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ 2019; 97:548-562P. [PMID: 31384073 PMCID: PMC6653813 DOI: 10.2471/blt.18.228486] [Citation(s) in RCA: 858] [Impact Index Per Article: 171.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/08/2019] [Accepted: 05/03/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To generate estimates of the global prevalence and incidence of urogenital infection with chlamydia, gonorrhoea, trichomoniasis and syphilis in women and men, aged 15-49 years, in 2016. METHODS For chlamydia, gonorrhoea and trichomoniasis, we systematically searched for studies conducted between 2009 and 2016 reporting prevalence. We also consulted regional experts. To generate estimates, we used Bayesian meta-analysis. For syphilis, we aggregated the national estimates generated by using Spectrum-STI. FINDINGS For chlamydia, gonorrhoea and/or trichomoniasis, 130 studies were eligible. For syphilis, the Spectrum-STI database contained 978 data points for the same period. The 2016 global prevalence estimates in women were: chlamydia 3.8% (95% uncertainty interval, UI: 3.3-4.5); gonorrhoea 0.9% (95% UI: 0.7-1.1); trichomoniasis 5.3% (95% UI:4.0-7.2); and syphilis 0.5% (95% UI: 0.4-0.6). In men prevalence estimates were: chlamydia 2.7% (95% UI: 1.9-3.7); gonorrhoea 0.7% (95% UI: 0.5-1.1); trichomoniasis 0.6% (95% UI: 0.4-0.9); and syphilis 0.5% (95% UI: 0.4-0.6). Total estimated incident cases were 376.4 million: 127.2 million (95% UI: 95.1-165.9 million) chlamydia cases; 86.9 million (95% UI: 58.6-123.4 million) gonorrhoea cases; 156.0 million (95% UI: 103.4-231.2 million) trichomoniasis cases; and 6.3 million (95% UI: 5.5-7.1 million) syphilis cases. CONCLUSION Global estimates of prevalence and incidence of these four curable sexually transmitted infections remain high. The study highlights the need to expand data collection efforts at country level and provides an initial baseline for monitoring progress of the World Health Organization global health sector strategy on sexually transmitted infections 2016-2021.
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Affiliation(s)
- Jane Rowley
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Stephen Vander Hoorn
- School of Mathematics and Statistics, University of Melbourne, Melbourne, Australia
| | | | - Nicola Low
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Örebro, Sweden
| | - Laith J Abu-Raddad
- Department of Healthcare Policy and Research, Weill Cornell Medical College - Qatar, Doha, Qatar
| | - R Matthew Chico
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, England
| | - Alex Smolak
- Department of Healthcare Policy and Research, Weill Cornell Medical College - Qatar, Doha, Qatar
| | - Lori Newman
- Enteric and Sexually Transmitted Infections Branch, National Institute of Allergy and Infectious Diseases, Washington DC, United States of America
| | - Sami Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Soe Soe Thwin
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Melanie M Taylor
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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13
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Yan RL, Ye YF, Fan QY, Huang YH, Wen GC, Li LM, Cai YM, Feng TJ, Huang ZM. Chlamydia trachomatis infection among patients attending sexual and reproductive health clinics: A cross-sectional study in Bao'an District, Shenzhen, China. PLoS One 2019; 14:e0212292. [PMID: 30779755 PMCID: PMC6380618 DOI: 10.1371/journal.pone.0212292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/30/2019] [Indexed: 11/26/2022] Open
Abstract
This study aimed to estimate the prevalence of chlamydial trachomatis (CT) infection and explore its risk factors among patients attending sexual and reproductive health clinics in Shenzhen, China. We collected demographic and clinical information from attendees (aged 18–49). CT and Neisseria gonorrhoeae (NG) infection was determined by nucleic acid amplification test (NAAT) on self-collected urine specimens. Of 1,938 participants recruited, 10.3% (95% confidence interval [CI]: 9.6%-11.0%) tested positive for CT. Prevalence was similar between men (10.6% [85/804]; 95% CI, 9.5%–11.7%) and women (10.1% [115/1134]; 95% CI: 9.2%–11.0%). Being 18–25 years old (adjusted odds ratio [aOR] = 2.52; 95%CI:1.35–4.71), never tested for CT before (aOR = 2.42; 95%CI: 1.05–5.61) and infected with NG(aOR = 3.87; 95%CI: 2.10–7.10) were independently associated with CT infection. We found that CT infection is prevalent among patients attending sexual and reproductive health clinics in Shenzhen, China. A comprehensive program including CT screening, surveillance and treatment is urgently needed.
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Affiliation(s)
- Rui-Lin Yan
- Shenzhen Baoan Center for Chronic Disease Control, Shenzhen, China
| | - Yun-Feng Ye
- Shenzhen Baoan Center for Chronic Disease Control, Shenzhen, China
| | - Qin-Ying Fan
- Shenzhen Baoan Center for Chronic Disease Control, Shenzhen, China
| | - Yan-Hui Huang
- Shenzhen Baoan Center for Chronic Disease Control, Shenzhen, China
| | - Gui-Chun Wen
- Shenzhen Baoan Center for Chronic Disease Control, Shenzhen, China
| | - Li-Mei Li
- Shenzhen Baoan Center for Chronic Disease Control, Shenzhen, China
| | - Yu-Mao Cai
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Tie-Jian Feng
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Zhi-Ming Huang
- Shenzhen Baoan Center for Chronic Disease Control, Shenzhen, China
- * E-mail:
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14
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Pinsent A, Solomon AW, Bailey RL, Bid R, Cama A, Dean D, Goodhew B, Gwyn SE, Jack KR, Kandel RP, Kama M, Massae P, Macleod C, Mabey DCW, Migchelsen S, Müller A, Sandi F, Sokana O, Taoaba R, Tekeraoi R, Martin DL, White MT. The utility of serology for elimination surveillance of trachoma. Nat Commun 2018; 9:5444. [PMID: 30575720 PMCID: PMC6303365 DOI: 10.1038/s41467-018-07852-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/27/2018] [Indexed: 11/24/2022] Open
Abstract
Robust surveillance methods are needed for trachoma control and recrudescence monitoring, but existing methods have limitations. Here, we analyse data from nine trachoma-endemic populations and provide operational thresholds for interpretation of serological data in low-transmission and post-elimination settings. Analyses with sero-catalytic and antibody acquisition models provide insights into transmission history within each population. To accurately estimate sero-conversion rates (SCR) for trachoma in populations with high-seroprevalence in adults, the model accounts for secondary exposure to Chlamydia trachomatis due to urogenital infection. We estimate the population half-life of sero-reversion for anti-Pgp3 antibodies to be 26 (95% credible interval (CrI): 21–34) years. We show SCRs below 0.015 (95% confidence interval (CI): 0.0–0.049) per year correspond to a prevalence of trachomatous inflammation—follicular below 5%, the current threshold for elimination of active trachoma as a public health problem. As global trachoma prevalence declines, we may need cross-sectional serological survey data to inform programmatic decisions. Robust surveillance methods are needed for trachoma control and recrudescence monitoring, but existing methods have limitations. Here, Pinsent et al. analyse data from nine trachoma-endemic populations and provide operational thresholds for interpretation of serological data in low transmission and post-elimination settings.
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Affiliation(s)
- Amy Pinsent
- Department of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, 3004, Australia. .,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, 1211, Geneva 27, Switzerland.,Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Robin L Bailey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Rhiannon Bid
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Anaseini Cama
- International Agency for the Prevention of Blindness, Western Pacific Region, Suva, Fiji.,The Fred Hollows Foundation, Level 2, 61 Dunning Ave, Rosebury, NSW, 2018, Australia
| | - Deborah Dean
- UCSF Benioff Children's Hospital Oakland Research Institute, 5700 Martin Luther King Jr Way, Oakland, CA, 94609, USA
| | - Brook Goodhew
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA
| | - Sarah E Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA
| | - Kelvin R Jack
- Eyecare Department, Ministry of Health, Honiara, Solomon Islands
| | | | - Mike Kama
- Department of Communicable Diseases, Ministry of Health, Suva, Fiji
| | - Patrick Massae
- Department of Ophthalmology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Colin Macleod
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.,Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 6NG, UK
| | - David C W Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Stephanie Migchelsen
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Andreas Müller
- Centre for Eye Research Australia, Level 7/32 Gisborne St, East Melbourne, VIC, 3002, Australia
| | - Frank Sandi
- Department of Ophthalmology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,The University of Dodoma, Dodoma, Tanzania
| | - Oliver Sokana
- Eyecare Department, Ministry of Health, Honiara, Solomon Islands
| | - Raebwebwe Taoaba
- Eye Department, Ministry of Health and Medical Services, South Tarawa, Kiribati
| | - Rabebe Tekeraoi
- Eye Department, Ministry of Health and Medical Services, South Tarawa, Kiribati
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA
| | - Michael T White
- Malaria: Parasites & Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, 25-28 Rue du Dr Roux, 75015, Paris, France
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15
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Optimising sampling regimes and data collection to inform surveillance for trachoma control. PLoS Negl Trop Dis 2018; 12:e0006531. [PMID: 30307939 PMCID: PMC6181273 DOI: 10.1371/journal.pntd.0006531] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/15/2018] [Indexed: 11/19/2022] Open
Abstract
It is estimated that 190 million individuals are at risk of blindness from trachoma, and that control by mass drug administration (MDA) is reducing this risk in many populations. Programs are monitored using prevalence of follicular trachoma disease (TF) in children. However, as programs progress to low prevalence there are challenges interpreting this indirect measure of infection. PCR and sero-surveillance are being considered as complementary tools to monitor low-level transmission, but there are questions on how they can be most effectively used. We use a previously-published, mathematical model to explore the dynamic relationship between TF and PCR throughout a control program and a sero-catalytic model to evaluate the utility of two cross-sectional sero-surveys for estimating sero-conversion rates. The simulations show that whilst PCR is more sensitive than TF at detecting infection, the probability of detecting at least one positive individual declines during an MDA program more quickly for PCR than for TF (for the same sample size). Towards the end of a program there is a moderate chance of a random sample showing both low PCR prevalence and higher TF prevalence, which may contribute to the lack of correlation observed in epidemiological studies. We also show that conducting two cross-sectional sero-surveys 10 years apart can provide more precise and accurate estimation of epidemiological parameters than a single survey, supporting previous findings that whilst serology holds great promise, multiple cross-sections from the same community are needed to generate the most valuable information about transmission. These results highlight that the quantitative dynamics of infection and disease should be included alongside the many logistical and practical factors to be considered in designing a monitoring and evaluation strategy at the operational research level, in order to help subsequently inform data collection for individual country programs. Whilst our simulations provide some insight, they also highlight that some level of longitudinal, individual-level data on reinfection and disease may be needed to monitor elimination progress.
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16
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Marks M, Esau T, Asugeni R, Harrington R, Diau J, Toloka H, Asugeni J, Ansbro E, Solomon AW, Maclaren D, Redman-Maclaren M, Mabey DCW. Point-of-care tests for syphilis and yaws in a low-income setting - A qualitative study of healthcare worker and patient experiences. PLoS Negl Trop Dis 2018; 12:e0006360. [PMID: 29672524 PMCID: PMC5908063 DOI: 10.1371/journal.pntd.0006360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/02/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction The human treponematoses comprise venereal syphilis and the three non-venereal or endemic treponematoses yaws, bejel, and pinta. Serological assays remain the most common diagnostic method for all treponemal infections. Point-of-care tests (POCTs) for syphilis and yaws allow testing without further development of infrastructure in populations where routine laboratory facilities are not available. Alongside the test’s performance characteristics assessed through diagnostic evaluation, it is important to consider broader issues when rolling out a POCT. Experience with malaria POCT roll-out in sub-Saharan Africa has demonstrated that both healthcare worker and patient beliefs may play a major role in shaping the real-world use of POCTs. We conducted a qualitative study evaluating healthcare worker and patient perceptions of using a syphilis/yaws POCT in clinics in the East Malaita region of Malaita province in the Solomon Islands. Prior to the study serology was only routinely available at the local district hospital. Methods The POCT was deployed in the outpatient and ante-natal departments of a district hospital and four rural health clinics served by the hospital. Each site was provided with training and an SOP on the performance, interpretation and recording of results. Treatment for those testing positive was provided, in line with Solomon Islands Ministry of Health and Medical Services’ guidelines for syphilis and yaws respectively. Alongside the implementation of the POCT we facilitated semi-structured interviews with both nurses and patients to explore individuals’ experiences and beliefs in relation to use of the POCT. Results and discussion Four main themes emerged in the interviews: 1) training and ease of performing the test; 2) time taken and ability to fit the test into a clinical workflow; 3) perceived reliability and trustworthiness of the test; and 4) level of the health care system the test was most usefully deployed. Many healthcare workers related their experience with the POCT to their experience using similar tests for malaria. Although the test was considered to take a relatively long time to perform the benefits of improved access to testing were considered positive by most healthcare workers. Qualitative data is needed to help inform better training packages to support the implementation of POCT in low-resource settings. Syphilis and yaws are closely related bacterial infections. In many countries where the diseases are found there is limited access to diagnostic testing. Recently a point of care test for both diseases has been developed. In the current study we evaluated the experience of healthcare workers and patients in using the test in the Solomon Islands. Both healthcare workers and patients valued the improved access to testing that provided by the point of care test. Experience of healthcare workers in using similar tests for other diseases, such as malaria, had both positive and negative impacts on their beliefs about the syphilis and yaws test.
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Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom
- * E-mail:
| | - Tommy Esau
- Atoifi Adventist Hospital, Atoifi, Malaita Province, Solomon Islands
| | - Rowena Asugeni
- Atoifi Adventist Hospital, Atoifi, Malaita Province, Solomon Islands
| | - Relmah Harrington
- Atoifi Adventist Hospital, Atoifi, Malaita Province, Solomon Islands
| | - Jason Diau
- Atoifi Adventist Hospital, Atoifi, Malaita Province, Solomon Islands
| | - Hilary Toloka
- Atoifi Adventist Hospital, Atoifi, Malaita Province, Solomon Islands
| | - James Asugeni
- Atoifi Adventist Hospital, Atoifi, Malaita Province, Solomon Islands
| | - Eimhin Ansbro
- Department of Noncommunicable Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anthony W. Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom
| | - David Maclaren
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | | | - David C. W. Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom
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17
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Butcher R, Sokana O, Jack K, Sui L, Russell C, Last A, Martin DL, Burton MJ, Solomon AW, Mabey DCW, Roberts CH. Clinical signs of trachoma are prevalent among Solomon Islanders who have no persistent markers of prior infection with Chlamydia trachomatis. Wellcome Open Res 2018; 3:14. [PMID: 29588922 PMCID: PMC5854984 DOI: 10.12688/wellcomeopenres.13423.2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2018] [Indexed: 01/15/2023] Open
Abstract
Background: The low population prevalence of trachomatous trichiasis and high prevalence of trachomatous inflammation–follicular (TF) provide contradictory estimates of the magnitude of the public health threat from trachoma in the Solomon Islands. Improved characterisation of the biology of trachoma in the region may support policy makers as they decide what interventions are required. Here, age-specific profiles of anti-Pgp3 antibodies and conjunctival scarring were examined to determine whether there is evidence of ongoing transmission and pathology from ocular
Chlamydia trachomatis (
Ct)
infection. Methods: A total of 1511 individuals aged ≥1 year were enrolled from randomly selected households in 13 villages in which >10% of children aged 1–9 years had TF prior to a single round of azithromycin mass drug administration undertaken six months previously. Blood was collected to be screened for antibodies to the
Ct antigen Pgp3. Tarsal conjunctival photographs were collected for analysis of scarring severity. Results: Anti-Pgp3 seropositivity was 18% in 1–9 year olds, sharply increasing around the age of sexual debut to reach 69% in those over 25 years. Anti-Pgp3 seropositivity did not increase significantly between the ages of 1–9 years and was not associated with TF (p=0.581) or scarring in children (p=0.472). Conjunctival scars were visible in 13.1% of photographs. Mild (p<0.0001) but not severe (p=0.149) scars increased in prevalence with age. Conclusions: Neither conjunctival scars nor lymphoid follicles were associated with antibodies to
Ct, suggesting that they are unlikely to be a direct result of ocular
Ct infection
. Clinical signs of trachoma were prevalent in this population but were not indicative of the underlying rates of
Ct infection. The current World Health Organization guidelines for trachoma elimination indicated that this population should receive intervention with mass distribution of antibiotics, but the data presented here suggest that this may not have been appropriate.
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Affiliation(s)
- Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Oliver Sokana
- Eye Department, Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Kelvin Jack
- Eye Department, Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Leslie Sui
- Primary Care Department, Lata Hospital, Lata, Solomon Islands
| | | | - Anna Last
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew J Burton
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - David C W Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Chrissy H Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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18
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Butcher R, Sokana O, Jack K, Sui L, Russell C, Last A, Martin DL, Burton MJ, Solomon AW, Mabey DC, Roberts CH. Clinical signs of trachoma are prevalent among Solomon Islanders who have no persistent markers of prior infection with Chlamydia trachomatis. Wellcome Open Res 2018; 3:14. [PMID: 29588922 PMCID: PMC5854984 DOI: 10.12688/wellcomeopenres.13423.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2018] [Indexed: 06/28/2024] Open
Abstract
Background: The low population-prevalence of trachomatous trichiasis and high prevalence of trachomatous inflammation-follicular (TF) provide contradictory estimates of the magnitude of the public health threat from trachoma in the Solomon Islands. Improved characterisation of the biology of trachoma in the region may support policy makers as they decide what interventions are required. Here, age-specific profiles of anti-Pgp3 antibodies and conjunctival scarring were examined to determine whether there is evidence of ongoing transmission and pathology from ocular Chlamydia trachomatis (Ct) infection. Methods: A total of 1511 individuals aged ≥1 year were enrolled from randomly selected households in 13 villages in which >10% of children aged 1-9 years had TF prior to a single round of azithromycin mass drug administration undertaken six months previously. Blood was collected to be screened for antibodies to the Ct antigen Pgp3. Tarsal conjunctival photographs were collected for analysis of scarring severity. Results: Anti-Pgp3 seropositivity was 18% in 1-9 year olds, sharply increasing around the age of sexual debut to reach 69% in those over 25 years. Anti-Pgp3 seropositivity did not increase significantly between the ages of 1-9 years and was not associated with TF (p=0.581) or scarring in children (p=0.472). Conjunctival scars were visible in 13.1% of photographs. Mild (p<0.0001) but not severe (p=0.149) scars increased in prevalence with age. Conclusions: Neither conjunctival scars nor lymphoid follicles were associated with antibodies to Ct, suggesting that they are unlikely to be a direct result of ocular Ct infection . Clinical signs of trachoma were prevalent in this population but were not indicative of the underlying rates of Ct infection. The current World Health Organization guidelines for trachoma elimination indicated that this population should receive intervention with mass distribution of antibiotics, but the data presented here suggest that this may not have been appropriate.
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Affiliation(s)
- Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Oliver Sokana
- Eye Department, Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Kelvin Jack
- Eye Department, Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Leslie Sui
- Primary Care Department, Lata Hospital, Lata, Solomon Islands
| | | | - Anna Last
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew J. Burton
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W. Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - David C.W. Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Chrissy h. Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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19
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Tadesse E, Teshome M, Amsalu A, Shimelis T. Genital Chlamydia trachomatis Infection among Women of Reproductive Age Attending the Gynecology Clinic of Hawassa University Referral Hospital, Southern Ethiopia. PLoS One 2016; 11:e0168580. [PMID: 28006003 PMCID: PMC5178988 DOI: 10.1371/journal.pone.0168580] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 12/02/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Urogenital infection with Chlamydia trachomatis(CT) is one of the most common bacterial sexually transmitted infections (STIs) world-wide, especially in developing nations where routine laboratory diagnosis is unavailable. Little is known about the epidemiology of this infection in Ethiopia where other STIs are prevalent. This study was conducted to determine the prevalence and associated factors of CT infection among women of reproductive age. METHODS A cross-sectional study was conducted among 322 consecutive women aged between 15-49 years at Hawassa University Referral Hospital from November 2014 to April 2015. Data on socio-demography and potential risk factors for genital infection were collected using structured questionnaires. Moreover, endocervical swabs were collected from all participants, screened for CT antigen using rapid immunochromatography assay, and cultured following the standard bacteriological method to isolate Neisseria gonorrhoeae. RESULT In this study, the overall prevalence of CT antigen and N. gonorrhoeae infection was 61(18.9%) and 1(0.31%), respectively. Women aged 15-24 years had the highest prevalence of CT infection (24.2%), followed by those aged 25-34 years (16.8%) and those aged 35-49 years (9.6%). CTinfection was associated with women who had unprotected sex within the last six months (aOR = 3.459; 95% CI = 1.459-8.222) and were sexually active for 6-10 years (aOR = 3.076; 95% CI = 1.152-8.209). None of the clinical symptoms and diagnoses was significantly associated with CT antigen positivity. CONCLUSIONS The high prevalence of genital CT infection in this study highlights the need for further large-scale studies on the general population. Thus, screening of women regardless of their symptoms should be in place.
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Affiliation(s)
- Endale Tadesse
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Million Teshome
- Gynecology and Obstetrics Unit, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Anteneh Amsalu
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Techalew Shimelis
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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20
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Sokana O, Macleod C, Jack K, Butcher R, Marks M, Willis R, Chu BK, Posala C, Solomon AW. Mapping Trachoma in the Solomon Islands: Results of Three Baseline Population-Based Prevalence Surveys Conducted with the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2016; 23:15-21. [PMID: 27937043 PMCID: PMC5706973 DOI: 10.1080/09286586.2016.1238946] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: We sought to complete the baseline trachoma map of the Solomon Islands by establishing prevalences of active trachoma and trichiasis in the provinces of Choiseul, Western, Rennell-Bellona, and Temotu. Methods: Using the standardized methodology developed for the Global Trachoma Mapping Project, we conducted cross-sectional community-based surveys from September to November 2013. Choiseul and Western provinces were each mapped as separate evaluation units (EUs); Rennell-Bellona and Temotu were combined to form a third EU. Results: A total of 9819 individuals were sampled for inclusion, with 9224 (93.3%) consenting to examination, of whom 4587 (46.3%) were female. Survey teams visited 82 villages, and surveyed 2448 households. Two EUs had prevalences of trachomatous inflammation – follicular (TF) in 1–9-year-olds over the 10% threshold at which WHO recommends mass distribution of azithromycin for at least 3 years (Western 20.4%, 95% confidence interval, CI 15.6–26.3%; Rennell-Bellona/Temotu 22.0%, 95% CI 18.5–26.0%). Choiseul had a TF prevalence of 6.1% (95% CI 4.1–8.6%), and met the criterion for a single round of mass antibiotic distribution before re-survey. The adjusted prevalences of trichiasis in those aged 15+ years were 0.0% (95% CI 0.0–0.2%) in Choiseul, 0.16% (95% CI 0.0–0.5%) in Western, and 0.10% (95% CI 0–0.3%) in Rennell-Bellona/Temotu provinces. All three EUs require implementation of the facial cleanliness and environmental improvement components of the trachoma elimination strategy. Conclusion: Active trachoma is prevalent in the Solomon Islands. However, there is little evidence of the blinding complications of trachoma being a public health problem there. Further research into the explanation for this phenomenon is warranted.
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Affiliation(s)
- Oliver Sokana
- a Eyecare Department , Ministry of Health , Honiara , Solomon Islands
| | - Colin Macleod
- b Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,c Sightsavers, Haywards Heath , UK
| | - Kelvin Jack
- a Eyecare Department , Ministry of Health , Honiara , Solomon Islands
| | - Robert Butcher
- b Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| | - Michael Marks
- b Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,d Hospital for Tropical Diseases , London , UK
| | | | - Brian K Chu
- e Task Force for Global Health , Decatur , GA , USA
| | - Claude Posala
- a Eyecare Department , Ministry of Health , Honiara , Solomon Islands
| | - Anthony W Solomon
- b Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
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Butcher RMR, Sokana O, Jack K, Macleod CK, Marks ME, Kalae E, Sui L, Russell C, Tutill HJ, Williams RJ, Breuer J, Willis R, Le Mesurier RT, Mabey DCW, Solomon AW, Roberts CH. Low Prevalence of Conjunctival Infection with Chlamydia trachomatis in a Treatment-Naïve Trachoma-Endemic Region of the Solomon Islands. PLoS Negl Trop Dis 2016; 10:e0004863. [PMID: 27603015 PMCID: PMC5014345 DOI: 10.1371/journal.pntd.0004863] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/29/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Trachoma is endemic in several Pacific Island states. Recent surveys across the Solomon Islands indicated that whilst trachomatous inflammation-follicular (TF) was present at levels warranting intervention, the prevalence of trachomatous trichiasis (TT) was low. We set out to determine the relationship between chlamydial infection and trachoma in this population. METHODS We conducted a population-based trachoma prevalence survey of 3674 individuals from two Solomon Islands provinces. Participants were examined for clinical signs of trachoma. Conjunctival swabs were collected from all children aged 1-9 years. We tested swabs for Chlamydia trachomatis (Ct) DNA using droplet digital PCR. Chlamydial DNA from positive swabs was enriched and sequenced for use in phylogenetic analysis. RESULTS We observed a moderate prevalence of TF in children aged 1-9 years (n = 296/1135, 26.1%) but low prevalence of trachomatous inflammation-intense (TI) (n = 2/1135, 0.2%) and current Ct infection (n = 13/1002, 1.3%) in children aged 1-9 years, and TT in those aged 15+ years (n = 2/2061, 0.1%). Ten of 13 (76.9%) cases of infection were in persons with TF or TI (p = 0.0005). Sequence analysis of the Ct-positive samples yielded 5/13 (38%) complete (>95% coverage of reference) genome sequences, and 8/13 complete plasmid sequences. Complete sequences all aligned most closely to ocular serovar reference strains. DISCUSSION The low prevalence of TT, TI and Ct infection that we observed are incongruent with the high proportion of children exhibiting signs of TF. TF is present at levels that apparently warrant intervention, but the scarcity of other signs of trachoma indicates the phenotype is mild and may not pose a significant public health threat. Our data suggest that, whilst conjunctival Ct infection appears to be present in the region, it is present at levels that are unlikely to be the dominant driving force for TF in the population. This could be one reason for the low prevalence of TT observed during the study.
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Affiliation(s)
- Robert M. R. Butcher
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Oliver Sokana
- Eye Department, Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Kelvin Jack
- Eye Department, Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Colin K. Macleod
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Sightsavers, Haywards Heath, United Kingdom
| | - Michael E. Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals, London, United Kingdom
| | - Eric Kalae
- Primary Care Department, Lata Hospital, Lata, Santa Cruz, Solomon Islands
| | - Leslie Sui
- Primary Care Department, Lata Hospital, Lata, Santa Cruz, Solomon Islands
| | | | - Helena J. Tutill
- Division of Infection & Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Rachel J. Williams
- Division of Infection & Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Judith Breuer
- Division of Infection & Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Rebecca Willis
- Task Force for Global Health, Decatur, Georgia, United States of America
| | - Richard T. Le Mesurier
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - David C. W. Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals, London, United Kingdom
| | - Anthony W. Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chrissy h. Roberts
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Marks M, Bottomley C, Tome H, Pitakaka R, Butcher R, Sokana O, Kako H, Solomon AW, Mabey DC. Mass drug administration of azithromycin for trachoma reduces the prevalence of genital Chlamydia trachomatis infection in the Solomon Islands. Sex Transm Infect 2016; 92:261-5. [PMID: 26888658 PMCID: PMC4893086 DOI: 10.1136/sextrans-2015-052439] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/23/2016] [Indexed: 11/30/2022] Open
Abstract
Objectives Chlamydia trachomatis is the most common bacterial sexually transmitted infection and is frequently asymptomatic; ocular C. trachomatis strains cause trachoma. Mass drug administration (MDA) of azithromycin for trachoma might also reduce the prevalence of genital C. trachomatis. In a survey conducted in the Solomon Islands in 2014, prior to MDA, the prevalence of genital C. trachomatis was 20.3% (95% CI 15.9% to 25.4%). We conducted a survey to establish the impact of MDA with azithromycin on genital C. trachomatis. Methods Women attending three community outpatient clinics, predominantly for antenatal care, 10 months after MDA with azithromycin given for trachoma elimination, were enrolled in this survey. Self-taken high vaginal swabs were for C. trachomatis and Neisseria gonorrhoeae using the BD Probetec strand displacement assay. Results 298 women were enrolled. C. trachomatis infection was diagnosed in 43 women (14.4%, 95% CI 10.6% to 18.9%) and N. gonorrhoeae in 9 (3%, 95% CI 1.4% to 5.7%). The age-adjusted OR for C. trachomatis infection was consistent with a significant decrease in the prevalence of C. trachomatis following MDA (OR 0.58, 95% CI 0.37 to 0.94, p=0.027). There was no change in the prevalence of N. gonorrhoeae between following MDA (OR 0.51, 95% CI 0.22 to 1.22, p=0.13). Conclusions This study demonstrated a 40% reduction in the age-adjusted prevalence of genital C. trachomatis infection following azithromycin MDA for trachoma elimination.
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Affiliation(s)
- M Marks
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| | - C Bottomley
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - H Tome
- Nursing Division, Honiara City Council, Honiara, Solomon Islands
| | - R Pitakaka
- National Referral Hospital, Honiara, Solomon Islands
| | - R Butcher
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - O Sokana
- Eye Health Department, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - H Kako
- Department of STI and HIV Prevention, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - A W Solomon
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| | - D C Mabey
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
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