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Kularatne R, Blondeel K, Kasaro M, Maseko V, Bosomprah S, Silva R, Laverty M, Kurbonov F, Mirandola M, Peeling RW. Clinic-based evaluation of point-of-care dual HIV/syphilis rapid diagnostic tests at primary healthcare antenatal facilities in South Africa and Zambia. BMC Infect Dis 2024; 24:600. [PMID: 38898466 PMCID: PMC11186134 DOI: 10.1186/s12879-024-09463-1] [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] [Received: 08/18/2022] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Southern African countries have the largest global burden of HIV and syphilis, with a high prevalence among women of reproductive age. Although antenatal screening is standard of care, syphilis screening has generally lagged behind HIV screening. We aimed to evaluate the performance and operational characteristics of two commercial dual HIV/syphilis point-of-care tests (POCTs) for simultaneous maternal HIV/syphilis screening. METHODS A clinic-based evaluation of dual HIV/syphilis POCTs (SD Bioline and Chembio) was conducted at five primary healthcare centres (PHCs) in South Africa and Zambia. POCT results using capillary fingerprick blood were compared to reference laboratory syphilis and HIV serological assays. RESULTS Three thousand four hundred twelve consenting pregnant women aged ≥ 18 years were enrolled. The prevalence of treponemal antibody seropositivity and HIV infection ranged from 3.7 to 9.9% (n = 253) and 17.8 to 21.3% (n = 643), respectively. Pooled sensitivity for syphilis compared to the reference assay was 66.0% (95%CI 57.7-73.4) with SD Bioline and 67.9% (95%CI 58.2-76.3) with Chembio. Pooled specificity for syphilis was above 98% with both POCTs. The sensitivities of SD Bioline and Chembio assays were 78.0% (95%CI 68.6-85.7) and 81.0% (95%CI 71.9-88.2), respectively compared to an active syphilis case definition of treponemal test positive with a rapid plasma reagin titre of ≥ 8. The negative predictive values (NPVs) based on various prevalence estimates for syphilis with both assays ranged from 97 to 99%. The pooled sensitivity for HIV was 92.1% (95%CI 89.4-94.2) with SD Bioline; and 91.5% (95%CI 88.2-93.9) with Chembio. The pooled specificities for HIV were 97.2% (95%CI 94.8-98.5) with SD Bioline and 96.7% (95%CI 95.1-97.8) with Chembio. The NPV based on various prevalence estimates for HIV with both assays was approximately 98%. Most participating women (91%) preferred dual POCTs over two single POCTs for HIV and syphilis, and healthcare providers gave favourable feedback on the utility of both assays at PHC level. CONCLUSIONS Based on the need to improve antenatal screening coverage for syphilis, dual HIV/syphilis POCTs could be effectively incorporated into antenatal testing algorithms to enhance efforts towards elimination of mother-to-child transmission of these infections.
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Affiliation(s)
- Ranmini Kularatne
- Centre for HIV & STI, National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Clinical Microbiology & Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karel Blondeel
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Margaret Kasaro
- University of North Carolina Global Projects Zambia, Lusaka, Zambia
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, USA
- Center for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Venessa Maseko
- Centre for HIV & STI, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Samuel Bosomprah
- Center for Infectious Diseases Research in Zambia, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | | | | | | | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy
| | - Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Verona, UK
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Hufstetler K, Llata E, Miele K, Quilter LAS. Clinical Updates in Sexually Transmitted Infections, 2024. J Womens Health (Larchmt) 2024; 33:827-837. [PMID: 38770770 DOI: 10.1089/jwh.2024.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Sexually transmitted infections (STIs) continue to increase in the United States with more than 2.5 million cases of gonorrhea, chlamydia, and syphilis reported to the Centers for Disease Control and Prevention in 2022. Untreated STIs in women can lead to adverse outcomes, including pelvic inflammatory disease, infertility, chronic pelvic pain, and pregnancy complications such as ectopic pregnancy, early pregnancy loss, stillbirth, and neonatal transmission. STI-related guidelines can be complex and are frequently updated, making it challenging to stay informed on current guidance. This article provides high-yield updates to support clinicians managing STIs by highlighting changes in screening, diagnosis, and treatment. One important topic includes new guidance on syphilis screening, including a clarified description of high community rates of syphilis based on Healthy People 2030 goals, defined as a case rate of primary or secondary syphilis > 4.6 per 100,000. Reproductive aged persons living in counties above this threshold should be offered syphilis screening. Additionally, American College of Obstetricians & Gynecologists now recommends syphilis screening three times during pregnancy regardless of risk-at the first prenatal visit, during the third trimester, and at delivery. In addition, new guidance to support consideration for extragenital screening for gonorrhea and chlamydia in women at sites such as the anus and pharynx is discussed. Other topics include the most recent chlamydia, gonorrhea, trichomoniasis, and pelvic inflammatory disease treatment recommendations; screening and treatment guidance for Mycoplasma genitalium; genital herpes screening indications and current diagnostic challenges; and the diagnosis and management of mpox in women and during pregnancy.
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Affiliation(s)
- Kaitlin Hufstetler
- CDC Foundation, Atlanta, Georgia, USA
- Division of STD Prevention; National Center for HIV, Viral Hepatitis, STD, and TB Prevention; Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eloisa Llata
- Division of STD Prevention; National Center for HIV, Viral Hepatitis, STD, and TB Prevention; Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn Miele
- Division of STD Prevention; National Center for HIV, Viral Hepatitis, STD, and TB Prevention; Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura A S Quilter
- Division of STD Prevention; National Center for HIV, Viral Hepatitis, STD, and TB Prevention; Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Grebely J, Matthews S, Causer LM, Feld JJ, Cunningham P, Dore GJ, Applegate TL. We have reached single-visit testing, diagnosis, and treatment for hepatitis C infection, now what? Expert Rev Mol Diagn 2024; 24:177-191. [PMID: 38173401 DOI: 10.1080/14737159.2023.2292645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Progress toward hepatitis C virus (HCV) elimination is impeded by low testing and treatment due to the current diagnostic pathway requiring multiple visits leading to loss to follow-up. Point-of-care testing technologies capable of detecting current HCV infection in one hour are a 'game-changer.' These tests enable diagnosis and treatment in a single visit, overcoming the barrier of multiple visits that frequently leads to loss to follow-up. Combining point-of-care HCV antibody and RNA tests should improve cost-effectiveness, patient/provider acceptability, and testing efficiency. However, implementing HCV point-of-care testing programs at scale requires multiple considerations. AREAS COVERED This commentary explores the need for point-of-care HCV tests, diagnostic strategies to improve HCV testing, key considerations for implementing point-of-care HCV testing programs, and remaining challenges for point-of-care testing (including operator training, quality management, connectivity and reporting systems, regulatory approval processes, and the need for more efficient tests). EXPERT OPINION It is exciting that single-visit testing, diagnosis, and treatment for HCV infection have been achieved. Innovations afforded through COVID-19 should facilitate the accelerated development of low-cost, rapid, and accurate tests to improve HCV testing. The next challenge will be to address barriers and facilitators for implementing point-of-care testing to deliver them at scale.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Susan Matthews
- Flinders University International Centre for Point-of-Care Testing, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Louise M Causer
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Canada
| | - Philip Cunningham
- Flinders University International Centre for Point-of-Care Testing, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Tanya L Applegate
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
- NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, Sydney, New South Wales, Australia
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Jia DT, Carcamo PM, Diaz MM. Ongoing Healthcare Disparities in neuroHIV: Addressing Gaps in the Care Continuum. Curr HIV/AIDS Rep 2023; 20:368-378. [PMID: 37999827 DOI: 10.1007/s11904-023-00683-9] [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] [Accepted: 11/10/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW We aim to review the neurological complications of HIV and the social, cultural, and economic inequalities that contribute to disparities in neuroHIV care. RECENT FINDINGS Disparities in diagnostics and care of patients with neurological infections and non-infectious conditions associated with HIV in both high-income and low-to-middle-income countries (LMIC) are common. The COVID-19 pandemic has exacerbated these disparities. Factors, such as HIV-related stigma, may deter people from accessing HIV treatment. First-line recommended treatments for neurological infections are not available in many LMICs, leading to inadequate treatment and exposure to agents with more harmful side effect profiles. Access-related factors, such as lack of transportation, lack of health insurance, and inadequate telehealth access, may increase the risk of HIV-related neurological complications. Further research is needed to increase awareness of neurological complications among providers and PWH, and regional guidelines should be considered to better address these complications.
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Affiliation(s)
- Dan Tong Jia
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Paloma M Carcamo
- Laboratory of Epidemiology and Public Health, Yale School of Public Health, New Haven, CT, USA
- Health Innovation Laboratory, Alexander Von Humboldt Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Monica M Diaz
- Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
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Zhang Y, Guy R, Camara H, Applegate TL, Wiseman V, Treloar C, Lafferty L. Barriers and facilitators to HIV and syphilis rapid diagnostic testing in antenatal care settings in low-income and middle-income countries: a systematic review. BMJ Glob Health 2022; 7:bmjgh-2022-009408. [PMID: 36319030 PMCID: PMC9628546 DOI: 10.1136/bmjgh-2022-009408] [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] [Received: 04/20/2022] [Accepted: 09/24/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Testing and treatment during pregnancy is a well-established and cost-effective prevention strategy, which relies largely on use of rapid diagnostic tests (RDTs). Yet, in many low-income and-middle-income countries, the uptake of RDTs is suboptimal. A qualitative meta-synthesis was conducted to identify the barriers and enablers to use of HIV and syphilis RDTs among pregnant women in low-income and middle-income countries. METHODS This review was conducted using PRISMA guidelines. Eligible studies included peer-reviewed publications, which used qualitative methods to explore HIV and syphilis RDT in antenatal care clinics in low-income and middle-income countries. Studies focusing on perspectives of pregnant women, healthcare workers and/or stakeholders were included. We used an inductive approach informed by a modified socioecological model to synthesise the data. RESULTS 62 manuscripts met the eligibility criteria. For pregnant women, initial acceptance of the RDT and continuation in antenatal care depends on the perception that engaging in testing will be a beneficial experience for their baby and themselves, often influenced by the provision of services that are gender-sensitive, confidential, respectful, flexible and considers their well-being into the future. Local sociocultural beliefs about pregnancy and diseases, awareness of diseases and gender roles in society also influenced RDT acceptability among pregnant women. For healthcare workers, the ability to provide high-quality RDT care required ongoing training, accurate and easy to use tests, support from supervisors and communities, sufficient resources and staffing to provide services, and reliable salary. At the stakeholder level, well-developed guidelines and health system infrastructures were imperative to the delivery of RDT in antenatal clinics. CONCLUSION Our findings highlight clear gaps to the provision of sustainable and culturally acceptable maternal HIV and/or syphilis screening using RDTs. In addition, greater attention needs to be paid to community stakeholders in promoting the uptake of RDT in antenatal clinics. PROSPERO REGISTRATION NUMBER CRD42018112190.
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Affiliation(s)
- Ye Zhang
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Hawa Camara
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Tanya L Applegate
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lise Lafferty
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
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Zhang H, Wang M, Zhang Y, Tan S, Huang H, Zhu J, Tian W, Mo J, Mo J, Cen P, Ning C. Usability of dual HIV/syphilis self-testing among men who have sex with men in China: study protocol for a three-arm randomised controlled trial. BMJ Open 2022; 12:e059034. [PMID: 36216414 PMCID: PMC9558798 DOI: 10.1136/bmjopen-2021-059034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION HIV self-testing (HIVST) provides a key measure for the early detection of HIV infection in men who have sex with men (MSM). However, dual HIV/syphilis self-testing in the MSM population has not been studied. We describe a randomised controlled trial to evaluate the effect of dual HIV/syphilis self-testing on the testing frequency among MSM in China. METHODS AND ANALYSIS This randomised controlled trial will be implemented in Guangxi, China. 330 MSM, including 255 frequent testers and 75 less frequent testers, will be recruited and randomly assigned in a 1:1:1 ratio into one of three arms: a site-based testing arm, a single HIVST arm and a dual HIV/syphilis self-testing arm. Participants in the single HIVST arm and dual HIV/syphilis self-testing arm will receive two free finger-prick-based HIVST or HIV/syphilis self-testing kits at enrolment. The data will be collected at five separate times: baseline, 3 months, 6 months, 9 months and 12 months. The primary outcome is the mean frequency of HIV testing used by MSM after intervention comparing each group during the study period. The secondary outcome includes changes in sex behaviours (eg, number of male sex partners and the proportion of consistent condom use) and the mean number of HIV tests used by the social network members over the study period. ETHICS AND DISSEMINATION The study protocol was reviewed and approved by the Medical Ethics Committee of Guangxi Medical University, China (20210173). The study results will be disseminated through conferences and academic journals. TRIAL REGISTRATION NUMBER ChiCTR2100050898.
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Affiliation(s)
- Hong Zhang
- Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Min Wang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Yun Zhang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Sumin Tan
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Haimei Huang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Jiawen Zhu
- The Second Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Weiyi Tian
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Jinli Mo
- The Second Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Jieling Mo
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Ping Cen
- AIDS/STD Control and Prevention, Nanning Municipal Center for Disease Prevention and Control, Nanning, Guangxi, China
| | - Chuanyi Ning
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
- Key Lab of AIDS Prevention and Treatment, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
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Shahid M, Bharali I, Hecht R, Yamey G. Approaches to improving the efficiency of HIV programme investments. BMJ Glob Health 2022; 7:bmjgh-2022-010127. [PMID: 36113892 PMCID: PMC9486198 DOI: 10.1136/bmjgh-2022-010127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Minahil Shahid
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Ipchita Bharali
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Robert Hecht
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Polonijo AN, Sein S, Maldonado R, Santos JD, Brown B. Promoting vaccination during rapid HIV testing: Recommendations from men who have sex with men in California. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2580-e2589. [PMID: 34985804 PMCID: PMC9253199 DOI: 10.1111/hsc.13702] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/29/2021] [Accepted: 12/17/2021] [Indexed: 05/31/2023]
Abstract
Community-based rapid HIV testing is effective for reaching racial-ethnically diverse men who have sex with men (MSM), offering an opportunity for bundled health promotion interventions. Given MSM experience a heightened prevalence of human papillomavirus (HPV) and meningococcal disease, we examined their preferences for bundling rapid HIV testing with an intervention to promote vaccination against these infections. In 2020, we conducted five virtual focus groups (N = 25 participants) in English and Spanish with MSM in Southern California's Inland Empire. Participants discussed their knowledge about HPV and meningitis vaccination and attitudes toward receiving vaccination information and referrals during rapid HIV tests. We used the rigorous and accelerated data reduction technique to systematically analyse the data. Participants had a mean age of 30, were socioeconomically diverse, and predominantly (68%) Hispanic. 96% had ever been tested for HIV, while only 28% were vaccinated against HPV and/or meningitis. Most participants were unaware of MSM's elevated risk for HPV and meningitis and were eager to receive vaccination information from LGBTQ+-friendly providers. However, many participants emphasised rapid HIV testing was stressful and anticipated feeling overwhelmed if presented with vaccination information in this setting. Preferred formats for vaccine promotion included pamphlets and resources that could be discretely accessed online, supported by broader advertising featuring diverse MSM on social media, dating apps, and posters in the community. Overall, our findings suggest that bundling health promotion messages with rapid HIV testing may be ineffective, as the anxiety associated with taking an HIV test may interfere with such messages and their impact.
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Affiliation(s)
- Andrea N. Polonijo
- Department of Sociology and the Health Sciences Research Institute, University of California, Merced, Merced, CA, USA
| | - Shawna Sein
- Continuing and Distance Education, University of Vermont, Burlington, VT, USA
| | | | | | - Brandon Brown
- Department of Social Medicine, Population and Public Health, University of California, Riverside, School of Medicine, Riverside, CA, US
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Coomes D, Green D, Barnabas R, Sharma M, Barr-DiChiara M, Jamil MS, Baggaley R, Owiredu MN, Macdonald V, Nguyen VTT, Vo SH, Taylor M, Wi T, Johnson C, Drake AL. Cost-effectiveness of implementing HIV and HIV/syphilis dual testing among key populations in Viet Nam: a modelling analysis. BMJ Open 2022; 12:e056887. [PMID: 35953255 PMCID: PMC9379490 DOI: 10.1136/bmjopen-2021-056887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Key populations, including sex workers, men who have sex with men, and people who inject drugs, have a high risk of HIV and sexually transmitted infections. We assessed the health and economic impacts of different HIV and syphilis testing strategies among three key populations in Viet Nam using a dual HIV/syphilis rapid diagnostic test (RDT). SETTING We used the spectrum AIDS impact model to simulate the HIV epidemic in Viet Nam and evaluated five testing scenarios among key populations. We used a 15-year time horizon and a provider perspective for costs. PARTICIPANTS We simulate the entire population of Viet Nam in the model. INTERVENTIONS We modelled five testing scenarios among key populations: (1) annual testing with an HIV RDT, (2) annual testing with a dual RDT, (3) biannual testing using dual RDT and HIV RDT, (4) biannual testing using HIV RDT and (5) biannual testing using dual RDT. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome is incremental cost-effectiveness ratios. Secondary outcomes include HIV and syphilis cases. RESULTS Annual testing using a dual HIV/syphilis RDT was cost-effective (US$10 per disability-adjusted life year (DALY)) and averted 3206 HIV cases and treated 27 727 syphilis cases compared with baseline over 15 years. Biannual testing using one dual test and one HIV RDT (US$1166 per DALY), or two dual tests (US$5672 per DALY) both averted an additional 875 HIV cases, although only the former scenario was cost-effective. Annual or biannual HIV testing using HIV RDTs and separate syphilis tests were more costly and less effective than using one or two dual RDTs. CONCLUSIONS Annual HIV and syphilis testing using dual RDT among key populations is cost-effective in Vietnam and similar settings to reach global reduction goals for HIV and syphilis.
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Affiliation(s)
- David Coomes
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Dylan Green
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Ruanne Barnabas
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Magdalena Barr-DiChiara
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S Jamil
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - R Baggaley
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Morkor Newman Owiredu
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Virginia Macdonald
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | - Son Hai Vo
- Viet Nam Authority for HIV/AIDS Prevention and Control, Government of Viet Nam Ministry of Health, Hanoi, Viet Nam
| | - Melanie Taylor
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Teodora Wi
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl Johnson
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Alison L Drake
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
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Point-of-Care Diagnostics for Diagnosis of Active Syphilis Infection: Needs, Challenges and the Way Forward. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138172. [PMID: 35805831 PMCID: PMC9265885 DOI: 10.3390/ijerph19138172] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023]
Abstract
Syphilis, a curable sexually transmitted infection, has re-emerged as a global public health threat with an estimated 5.6 million new cases every year. Pregnant women and men who have sex with men are key target populations for syphilis control and prevention programs. Frequent syphilis testing for timely and accurate diagnosis of active infections for appropriate clinical management is a key strategy to effectively prevent disease transmission. However, there are persistent challenges in the diagnostic landscape and service delivery/testing models that hinder global syphilis control efforts. In this commentary, we summarise the current trends and challenges in diagnosis of active syphilis infection and identify the data gaps and key areas for research and development of novel point-of-care diagnostics which could help to overcome the present technological, individual and structural barriers in access to syphilis testing. We present expert opinion on future research which will be required to accelerate the validation and implementation of new point-of-care diagnostics in real-world settings.
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Naidu P, Tsang RSW. Canadian Public Health Laboratory Network guidelines for the use of point-of-care tests for Treponema pallidum in Canada. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:85-96. [PMID: 36337357 PMCID: PMC9608113 DOI: 10.3138/jammi-2021-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 06/16/2023]
Abstract
Over the past few years, the increase in infectious syphilis outbreaks in major urban centres and remote or rural locations in Canada, often affecting hard-to-reach patient populations, has renewed an interest and urgency in studying the use of point-of-care tests (POCTs) that can provide test results at the time and place of primary health care delivery, obviating the repeat visit necessary with traditional syphilis serology or molecular diagnostic tests. In 2015, the Canadian Public Health Laboratory Network released its first laboratory guideline for the use of POCTs in the diagnosis of syphilis in Canada. Although Canada has no licensed POCT, two POCTs (Syphilis Health Check and the DPP® HIV Syphilis System) have received US Food and Drug Administration (FDA) approval under premarket approval applications. Most syphilis POCTs detect antibodies to treponemal antigens, so their results cannot be used to differentiate between active and past infection. The only POCT that detects antibodies to both treponemal and non-treponemal antigens does not yet have Health Canada or FDA approval. In this updated guideline, the current landscape of POCTs for syphilis, with an emphasis on data from low-prevalence countries, is described. Individual operators should consider the questions of where, when, how, and why a POCT is used before its actual implementation. Training in the operation and interpretation, quality control, proficiency program, safety, and careful documentation of the process and results are especially important for the successful implementation of POCTs.
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Affiliation(s)
- Prenilla Naidu
- Provincial Laboratory for Public Health, Edmonton, Alberta, Canada
| | - Raymond SW Tsang
- Syphilis Diagnostic Unit, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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Banerjee S, Bhatta M, Nandi S, Dutta S, Saha MK. Diagnostic Accuracy of HIV in-vitro Assays Evaluated by WHO Prequalification Evaluation Laboratories: Systematic Review and Meta-analysis. Jpn J Infect Dis 2022; 75:445-453. [PMID: 35354705 DOI: 10.7883/yoken.jjid.2021.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For maintaining the performance quality, HIV in-vitro diagnostic (IVD) kits are required to be evaluated by unbiased health regulatory organisation following predefined guidelines. WHO prequalification is one such program for evaluation of in-vitro diagnostic assays. In present systematic review and meta-analysis, we analysed and compared seventeen WHO prequalified public reports of HIV IVDs to yield summarised information for performance parameters. Pooled sensitivity, pooled specificity, Positive Likelihood Ratio (PLR), Negative Likelihood Ratio (NLR) and diagnostic odds ratio (DOR) were used as overall performance evaluation parameters. High (≥98%) and comparable level of sensitivity and specificity were observed for most of the assays. The overall diagnostic efficiency was observed to attain high precision as evident by the value of Area under the curve (AUC) for the hierarchical summary receiver operating characteristic (HSROC) curve (AUC≥0.98).
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Affiliation(s)
- Santanu Banerjee
- Division of Virology, ICMR-National Institute of Cholera and Enteric Diseases, India
| | - Mihir Bhatta
- Division of Virology, ICMR-National Institute of Cholera and Enteric Diseases, India
| | - Srijita Nandi
- Division of Virology, ICMR-National Institute of Cholera and Enteric Diseases, India
| | - Shanta Dutta
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, India
| | - Malay Kumar Saha
- Division of Virology, ICMR-National Institute of Cholera and Enteric Diseases, India
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Tsang RSW, Shuel M, Hayden K, Van Caeseele P, Stein D. Laboratory evaluation of two point-of-care test kits for the identification of infectious syphilis. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2022; 48:82-88. [PMID: 35342368 PMCID: PMC8889920 DOI: 10.14745/ccdr.v48i23a05] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Syphilis is a sexually transmitted disease that can have atypical clinical presentations. Conventional laboratory tests to confirm the diagnosis are not rapid enough to affect clinical decision on treatment and contact tracing. Rapid point-of-care tests (POCT) can be useful for control of infectious diseases; however, no POCT for syphilis detection is currently available in Canada. The aim of this study is to evaluate two POCTs (RevealTM Rapid TP (Treponema pallidum) Antibody test and DPP® Syphilis Screen and Confirm test) for detection of infectious syphilis. METHODS One hundred serum samples with known syphilis serological status, based on treponemal and non-treponemal test results, were analysed in the laboratory with two POCTs by two independent operators in a blind fashion. Results were analysed to evaluate their ability to detect infectious syphilis. RESULTS The Reveal Rapid TP Antibody POCT showed an overall sensitivity of 95.0% and a specificity of 83.3%, while the DPP Syphilis Screen and Confirm POCT showed a sensitivity of 87.5% and a specificity of 98.3%. Both POCTs gave a sensitivity of 100% on active syphilis samples with Venereal Disease Research Laboratory (VDRL) titres of greater than 1:4, but their sensitivities decreased for samples with low VDRL titres. Both POCTs gave weakly or very weakly reactive results on 11.3%-25.0% of the treponemal antibody positive samples. CONCLUSION This laboratory evaluation has shown promising results for both POCTs to detect infectious syphilis. Further evaluations in the field would be required to confirm this preliminary finding.
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Affiliation(s)
- Raymond SW Tsang
- Syphilis Diagnostic Unit, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Michelle Shuel
- Syphilis Diagnostic Unit, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Kristy Hayden
- Syphilis Diagnostic Unit, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | | | - Derek Stein
- Cadham Provincial Public Health Laboratory, Winnipeg, MB
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB
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Siregar KN, Hanifah L, Rikawarastuti, Wahyuniar L. Prevention of HIV Transmission from Mother to Child: Challenges to the Successful Program Implementation and Practice in Indonesia. J Int Assoc Provid AIDS Care 2021; 20:23259582211040701. [PMID: 34448424 PMCID: PMC8404671 DOI: 10.1177/23259582211040701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The level of human immunodeficiency virus (HIV) transmission from mother to child in Indonesia ranks first worldwide. Newborn babies in Indonesia are at greater risk of experiencing the burden of HIV infection than babies born in other countries. Objectives: To explore the full extent of Prevention of Mother to Child Transmission (PMTCT) in South Sulawesi Province in 2020 and to discuss program and policy implications for PMTCT. Methods: This is a health system analysis study with a qualitative approach using focus group discussion, in-depth interviews, and observations in primary health centers and hospitals. Results: There is no local policy and guidelines for PMTCT programs and services; the coverage of HIV testing in pregnant women has not achieved 100% according to the target. There are limitations to human resources in public and private services to conduct the program. The assistance’s activities to ensure antiretroviral (ARV) adherence are limited, and HIV-positive women faced stigma and discrimination, not only from the community but also from health workers. Recommendations: Some recommendations are to improve the HIV test coverage to 100% in pregnant women as well as the coverage and quality of ARV treatment.
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Affiliation(s)
| | - Laily Hanifah
- Faculty of Health Sciences, Veteran National Development University of Jakarta, Jakarta, Indonesia
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Gaspar PC, Bigolin Á, Alonso Neto JB, Pereira EDDS, Bazzo ML. Brazilian Protocol for Sexually Transmitted Infections 2020: syphilis diagnostic tests. Rev Soc Bras Med Trop 2021; 54:e2020630. [PMID: 34008728 PMCID: PMC8210484 DOI: 10.1590/0037-8682-630-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
The recommendations for diagnostic tests for investigating syphilis are part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections and the Technical Manual for Syphilis Diagnosis, published by the Brazilian Ministry of Health. These recommendations were developed based on scientific evidence and discussions with a panel of experts. This article presents direct tests to detect Treponema pallidum in lesions and algorithms that combine treponemal and non-treponemal antibody tests to assist in syphilis diagnosis, with the aim of contributing to the efforts of health service managers and health professionals in qualifying health care. The article also covers the use of non-treponemal tests to investigate neurosyphilis and guidelines for interpreting non-treponemal antibody titers in monitoring the treatment and diagnosis of congenital syphilis, as well as prospects for innovations in diagnosis. The critical role of rapid immunochromatographic treponemal tests for public health and for addressing syphilis is also highlighted. Highlighted excerpt: During the natural evolution of syphilis, activity periods with distinct clinical, immunological, and histopathological characteristics are interspersed with latent periods when there are no signs or symptoms, making access to tests critical for early diagnosis.
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Affiliation(s)
- Pâmela Cristina Gaspar
- Ministério da Saúde do Brasil, Secretaria de Vigilância em Saúde, Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis, Brasília, DF, Brasil.,Universidade de Brasília, Programa de Pós-Graduação em Saúde Coletiva, Brasília, DF, Brasil
| | - Álisson Bigolin
- Ministério da Saúde do Brasil, Secretaria de Vigilância em Saúde, Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis, Brasília, DF, Brasil.,Universidade Federal de Santa Catarina, Laboratório de Biologia Molecular, Microbiologia e Sorologia, Florianópolis, SC, Brasil
| | - José Boullosa Alonso Neto
- Ministério da Saúde do Brasil, Secretaria de Vigilância em Saúde, Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis, Brasília, DF, Brasil
| | - Esdras Daniel Dos Santos Pereira
- Ministério da Saúde do Brasil, Secretaria de Vigilância em Saúde, Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis, Brasília, DF, Brasil
| | - Maria Luiza Bazzo
- Universidade Federal de Santa Catarina, Laboratório de Biologia Molecular, Microbiologia e Sorologia, Florianópolis, SC, Brasil
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Brandenburger D, Ambrosino E. The impact of antenatal syphilis point of care testing on pregnancy outcomes: A systematic review. PLoS One 2021; 16:e0247649. [PMID: 33765040 PMCID: PMC7993761 DOI: 10.1371/journal.pone.0247649] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/10/2021] [Indexed: 12/26/2022] Open
Abstract
Background Mother-to-child transmission of syphilis remains a leading cause of neonatal death and stillbirth, disproportionally affecting women in low-resource settings where syphilis prevalence rates are high and testing rates low. Recently developed syphilis point-of-care tests (POCTs) are promising alternatives to conventional laboratory screening in low-resource settings as they do not require a laboratory setting, intensive technical training and yield results in 10–15 minutes thereby enabling both diagnosis and treatment in a single visit. Aim of this review was to provide clarity on the benefits of different POCTs and assess whether the implementation of syphilis POCTs is associated with decreased numbers of syphilis-related adverse pregnancy outcomes. Methods Following the PRISMA guidelines, three electronic databases (PubMed, Medline (Ovid), Cochrane) were systematically searched for intervention studies and cost-effectiveness analyses investigating the association between antenatal syphilis POCT and pregnancy outcomes such as congenital syphilis, low birth weight, prematurity, miscarriage, stillbirth as well as perinatal, fetal or infant death. Results Nine out of 278 initially identified articles were included, consisting of two clinical studies and seven modelling studies. Studies compared the effect on pregnancy outcomes of treponemal POCT, non-treponemal POCT and dual POCT to laboratory screening and no screening program. Based on the clinical studies, significantly higher testing and treatment rates, as well as a significant reduction (93%) in adverse pregnancy outcomes was reported for treponemal POCT compared to laboratory screening. Compared to no screening and laboratory screening, modelling studies assumed higher treatment rates for POCT and predicted the most prevented adverse pregnancy outcomes for treponemal POCT, followed by a dual treponemal and non-treponemal POCT strategy. Conclusion Implementation of treponemal POCT in low-resource settings increases syphilis testing and treatment rates and prevents the most syphilis-related adverse pregnancy outcomes compared to no screening, laboratory screening, non-treponemal POCT and dual POCT. Regarding the benefits of dual POCT, more research is needed. Overall, this review provides evidence on the contribution of treponemal POCT to healthier pregnancies and contributes greater clarity on the impact of diverse diagnostic methods available for the detection of syphilis.
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MESH Headings
- Abortion, Spontaneous/diagnosis
- Abortion, Spontaneous/economics
- Abortion, Spontaneous/prevention & control
- Cost-Benefit Analysis
- Developing Countries
- Female
- Humans
- Infant
- Infant Mortality/trends
- Infant, Low Birth Weight
- Infant, Newborn
- Infectious Disease Transmission, Vertical/prevention & control
- Infectious Disease Transmission, Vertical/statistics & numerical data
- Point-of-Care Testing/economics
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/economics
- Pregnancy Complications, Infectious/prevention & control
- Prenatal Diagnosis/economics
- Prenatal Diagnosis/methods
- Stillbirth
- Syphilis/diagnosis
- Syphilis/economics
- Syphilis/prevention & control
- Syphilis Serodiagnosis/economics
- Syphilis Serodiagnosis/methods
- Treponema pallidum/immunology
- Treponema pallidum/pathogenicity
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Affiliation(s)
- Dana Brandenburger
- Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Elena Ambrosino
- Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Development), Institute for Public Health Genomics (IPHG), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
- * E-mail:
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Eisinger RW, Erbelding E, Fauci AS. Refocusing Research on Sexually Transmitted Infections. J Infect Dis 2021; 222:1432-1434. [PMID: 31495889 DOI: 10.1093/infdis/jiz442] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 12/17/2022] Open
Abstract
This article highlights biomedical research goals for the development of critical tools, including innovative diagnostics, safe and effective vaccines, and new and improved therapeutics, necessary to achieve an end to the global epidemic of sexually transmitted infections. The incidence of sexually transmitted infections (STIs), including gonorrhea, syphilis, chlamydia, and trichomoniasis, is increasing by over 1 million new cases daily and represents a global public health crisis. There is an alarming increase of gonorrhea and syphilis among men who have sex with men and bisexual men, 2 key populations also at high risk for human immunodeficiency virus. A refocused, dedicated, and intensive biomedical research program is needed targeting development of innovative diagnostics, safe and effective vaccines, and new and improved therapeutics. This article highlights biomedical research goals providing critical tools necessary to achieve an end to the global STIs epidemic.
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Affiliation(s)
| | - Emily Erbelding
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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18
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Park HD. Current Status of Clinical Application of Point-of-Care Testing. Arch Pathol Lab Med 2021; 145:168-175. [PMID: 33053162 DOI: 10.5858/arpa.2020-0112-ra] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The clinical applications of point-of-care testing (POCT) are gradually increasing in many health care systems. Recently, POCT devices using molecular genetic method techniques have been developed. We need to examine clinical pathways to see where POCT can be applied to improve them. OBJECTIVE.— To introduce up-to-date POCT items and equipment and to provide the content that should be prepared for clinical application of POCT. DATA SOURCES.— Literature review based on PubMed searches containing the terms point-of-care testing, clinical chemistry, diagnostic hematology, and clinical microbiology. CONCLUSIONS.— If medical resources are limited, POCT can help clinicians make quick medical decisions. As POCT technology improves and menus expand, areas where POCT can be applied will also increase. We need to understand the limitations of POCT so that it can be optimally used to improve patient management.
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Affiliation(s)
- Hyung-Doo Park
- From the Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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19
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Duan CC, Zhang XH, Li SS, Wu W, Qiu LQ, Xu J. Risk Factors for Stillbirth among Pregnant Women Infected with Syphilis in the Zhejiang Province of China, 2010-2016. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2021; 2021:8877962. [PMID: 33603937 PMCID: PMC7872764 DOI: 10.1155/2021/8877962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND The World Health Organization estimated that about 1.36 million pregnant women suffered from syphilis in 2008, and nearly 66% of adverse effects occurred in those who were not tested or treated. Syphilis infection is one of the most common maternal factors associated with stillbirth. OBJECTIVE This study aimed to determine the risk factors for stillbirth among pregnant women infected with syphilis. METHODS In this retrospective study, data on stillbirth and gestational syphilis from 2010 to 2016 were extracted from the prevention of mother-to-child transmission (PMTCT) program database in the Zhejiang province. A total of 8,724 pregnant women infected with syphilis were included. Multiple logistic regression analysis was performed to determine the degree of association between gestational syphilis and stillbirth. RESULTS We found that the stillbirth percentage among pregnant women infected with syphilis was 1.7% (152/8,724). Compared with live births, stillbirth was significantly associated with lower maternal age, not being married, lower gravidity, the history of syphilis, nonlatent syphilis stage, higher maternal serum titer for syphilis, inadequate treatment for syphilis, and later first antenatal care visit. In multiple logistic analysis, nonlatent syphilis (adjusted odds ratio (AOR) = 2.03; 95% CI = 1.17, 3.53) and maternal titers over 1 : 4 (AOR = 1.78; 95% CI = 1.25, 2.53) were risk factors for stillbirth, and adequate treatment was the only protective factor for stillbirth (AOR = 0.16; 95% CI = 0.10, 0.25). CONCLUSIONS Nonlatent syphilis and maternal titers over 1 : 4 were risk factors for stillbirth, and adequate treatment was the only protective factor for stillbirth.
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Affiliation(s)
- Cui-Cui Duan
- Women's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Hui Zhang
- Women's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Shan-Shan Li
- The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Wu
- The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Li-Qian Qiu
- Women's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Xu
- Women's Hospital of Zhejiang University School of Medicine, Hangzhou, China
- The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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20
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Smith MH, Vargo RJ, Bilodeau EA, Anderson KM, Trzcinska A, Canterbury CR, Fantasia JE, Rawal YB. Oral Manifestations of Syphilis: a Review of the Clinical and Histopathologic Characteristics of a Reemerging Entity with Report of 19 New Cases. Head Neck Pathol 2021; 15:787-795. [PMID: 33459991 PMCID: PMC8384985 DOI: 10.1007/s12105-020-01283-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Syphilis is a sexually-transmitted infectious disease caused by Treponema pallidum. Cases of primary and secondary syphilis are on the rise in the United States, with a 14.4% increase in new cases noted from 2017 to 2018 and an escalation of 71% between the years 2014 and 2018. Fulfilling its nickname of "the great imitator," oral manifestations of syphilis may mimic a variety of infectious, neoplastic, or immune-mediated processes, both clinically and histopathologically. This large spectrum of appearances can create a diagnostic challenge to the clinician and/or pathologist, leading to delay in diagnosis or misdiagnosis. METHODS A database of oral syphilis cases was created from archives at the University of Kentucky, University of Pittsburgh, LIJMC, Columbia University MC, and University of Tennessee. The age, sex, race, location, duration, and clinical description were recorded. Cases without positive reaction upon immunohistochemistry or serologic tests were excluded. RESULTS We identified 19 new cases of oral syphilis (17 males, one female, and one case unknown sex) and described the clinical and histopathological features of this re-emerging and potentially fatal disease. All cases demonstrated dense lymphoplasmacytic inflammation, often with inflammatory exocytosis or ulceration at the surface, and perivascular inflammation. CONCLUSIONS Early recognition of the histopathologic and clinical manifestations of oral syphilis is imperative for prompt diagnosis, improved patient outcomes, and disease prevention.
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Affiliation(s)
- Molly Housley Smith
- Division of Oral and Maxillofacial Pathology, University of Kentucky College of Dentistry, 800 Rose Street, Rm. 530, Lexington, KY, 40536, USA.
| | - Richard J Vargo
- Oral and Maxillofacial Pathology Specialty Care Unit, A.T. Still University-Missouri School of Dentistry & Oral Health, St. Louis, MO, USA
| | - Elizabeth Ann Bilodeau
- Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, G-135 Salk Hall, 3501 Terrace St., Pittsburgh, PA, USA
| | - K Mark Anderson
- Department of Diagnostic Sciences, The University of Tennessee College of Dentistry, Memphis, TN, USA
| | - Anna Trzcinska
- Head and Neck Pathology Fellow, Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Carleigh R Canterbury
- Division of Oral and Maxillofacial Pathology, Columbia University Medical Center, New York, NY, USA
| | - John E Fantasia
- Department of Dental Medicine, Division of Oral and Maxillofacial Pathology, Long Island Jewish Medical Center, Zucker School of Medicine At Hofstra Northwell Health, New Hyde Park, NY, USA
| | - Yeshwant B Rawal
- Department of Surgical Sciences, Marquette University School of Dentistry, Milwaukee, WI, USA
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Rodriguez PJ, Roberts DA, Meisner J, Sharma M, Owiredu MN, Gomez B, Mello MB, Bobrik A, Vodianyk A, Storey A, Githuka G, Chidarikire T, Barnabas R, Barr-Dichiara M, Jamil MS, Baggaley R, Johnson C, Taylor MM, Drake AL. Cost-effectiveness of dual maternal HIV and syphilis testing strategies in high and low HIV prevalence countries: a modelling study. Lancet Glob Health 2021; 9:e61-e71. [PMID: 33227254 PMCID: PMC7783487 DOI: 10.1016/s2214-109x(20)30395-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dual HIV and syphilis testing might help to prevent mother-to-child transmission (MTCT) of HIV and syphilis through increased case detection and treatment. We aimed to model and assess the cost-effectiveness of dual testing during antenatal care in four countries with varying HIV and syphilis prevalence. METHODS In this modelling study, we developed Markov models of HIV and syphilis in pregnant women to estimate costs and infant health outcomes of maternal testing at the first antenatal care visit with individual HIV and syphilis tests (base case) and at the first antenatal care visit with a dual rapid diagnostic test (scenario one). We additionally evaluated retesting during late antenatal care and at delivery with either individual tests (scenario two) or a dual rapid diagnosis test (scenario three). We modelled four countries: South Africa, Kenya, Colombia, and Ukraine. Strategies with an incremental cost-effectiveness ratio (ICER) less than the country-specific cost-effectiveness threshold (US$500 in Kenya, $750 in South Africa, $3000 in Colombia, and $1000 in Ukraine) per disability-adjusted life-year averted were considered cost-effective. FINDINGS Routinely offering testing at the first antenatal care visit with a dual rapid diagnosis test was cost-saving compared with the base case in all four countries (ICER: -$26 in Kenya,-$559 in South Africa, -$844 in Colombia, and -$454 in Ukraine). Retesting during late antenatal care with a dual rapid diagnostic test (scenario three) was cost-effective compared with scenario one in all four countries (ICER: $270 in Kenya, $260 in South Africa, $2207 in Colombia, and $205 in Ukraine). INTERPRETATION Incorporating dual rapid diagnostic tests in antenatal care can be cost-saving across countries with varying HIV prevalence. Countries should consider incorporating dual HIV and syphilis rapid diagnostic tests as the first test in antenatal care to support efforts to eliminate MTCT of HIV and syphilis. FUNDING WHO, US Agency for International Development, and the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Patricia J Rodriguez
- The Comparative Health Outcomes Policy & Economics Institute, University of Washington, Seattle, WA, USA
| | - D Allen Roberts
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Julianne Meisner
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Morkor Newman Owiredu
- Global HIV, Hepatitis and Sexually Transmitted Infections Programme, WHO, Geneva, Switzerland
| | - Bertha Gomez
- Pan American Health Organization and WHO, Colombia Office, Bogotá DC, Colombia
| | - Maeve B Mello
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization and WHO, Washington DC, USA
| | - Alexey Bobrik
- Global Fund to Fight AIDS, Tuberculosis and Malaria, Grand-Saconnex, Switzerland
| | - Arkadii Vodianyk
- Department of Infectious Diseases, Ukraine Country Office, WHO, Kiev, Ukraine
| | - Andrew Storey
- Maternal and Neonatal Health, Clinton Health Access Initiative, Boston, MA, USA
| | | | - Thato Chidarikire
- HIV Prevention Programmes, National Department of Health, Pretoria, South Africa
| | - Ruanne Barnabas
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Magdalena Barr-Dichiara
- Global HIV, Hepatitis and Sexually Transmitted Infections Programme, WHO, Geneva, Switzerland
| | - Muhammad S Jamil
- Global HIV, Hepatitis and Sexually Transmitted Infections Programme, WHO, Geneva, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and Sexually Transmitted Infections Programme, WHO, Geneva, Switzerland
| | - Cheryl Johnson
- Global HIV, Hepatitis and Sexually Transmitted Infections Programme, WHO, Geneva, Switzerland; Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Melanie M Taylor
- Global HIV, Hepatitis and Sexually Transmitted Infections Programme, WHO, Geneva, Switzerland; Division of Sexually Transmitted Diseases Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, WA, USA.
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22
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Adamson PC, Loeffelholz MJ, Klausner JD. Point-of-Care Testing for Sexually Transmitted Infections: A Review of Recent Developments. Arch Pathol Lab Med 2020; 144:1344-1351. [PMID: 32810868 DOI: 10.5858/arpa.2020-0118-ra] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Sexually transmitted infections (STIs) are among the most common communicable diseases globally and are associated with significant morbidity and mortality worldwide. Point-of-care tests have the potential to revolutionize the prevention and control of STIs by enabling rapid diagnosis and early treatment of infections, thus interrupting transmission and preventing the sequelae of untreated infections. Currently, there are several point-of-care (POC) tests available for the diagnosis of Treponema pallidum, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis infections, although these tests differ with regard to their performance, turnaround time, and cost. OBJECTIVE.— To provide an updated review of the POC tests available and under development for the diagnosis of T pallidum, C trachomatis, N gonorrhoeae, and T vaginalis infections, to discuss the context for which these tests might be used, and to highlight future directions for test development. DATA SOURCES.— We reviewed the literature pertaining to the recent development and performance evaluations of POC tests for the diagnosis of syphilis, chlamydia, gonorrhea, and trichomonas. CONCLUSIONS.— Recently, there has been rapid development of new POC tests for STIs. Although there are inexpensive, rapid, and accurate POC tests available for syphilis, there are few such tests available for the diagnosis of chlamydia, gonorrhea, or trichomonas, and currently none with the ability to detect antimicrobial resistance in N gonorrhoeae. Research evaluating implementation strategies for the currently available tests and the development of additional POC tests that are rapid, accurate, and affordable are urgently needed to address the rising number of STIs worldwide.
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Affiliation(s)
- Paul C Adamson
- From the Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California (Adamson, Klausner)
| | | | - Jeffrey D Klausner
- From the Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California (Adamson, Klausner).,and the Fielding School of Public Health, University of California, Los Angeles (Klausner)
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[Rapid diagnosis of sexually transmitted infections : Joint statement of DSTIG, RKI, and PEI, as well as the reference centers for HIV, HBV, and HCV and consulting laboratories for Chlamydia, gonococci, and Treponema pallidum]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:1271-1286. [PMID: 32930821 DOI: 10.1007/s00103-020-03218-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In February 2019, the fourth expert meeting on rapid diagnostic tests (RDTs) for sexually transmitted infections (STI) was held at the Robert Koch Institute (RKI) in Berlin. Novel technical developments and new aspects of RDT applications were discussed by representatives from the German STI Society (DSTIG); RKI; the Paul Ehrlich Institute; national reference centers for HIV, HBV, and HCV; and reference laboratories for Chlamydia, gonococci, and Treponema pallidum.As a result of this meeting, we present a revision of the joint statement on STI diagnostics with RDTs from 2017. The Regulation (EU) 2017/746 of the European Parliament and of the Council on in vitro diagnostic medical devices became effective in May 2017 and includes more stringent regulatory requirements for RDTs, mainly concerning conformity of manufacturing processes and performance characteristics of class D in vitro diagnostics (detection of HIV, HBV, HCV, and T. pallidum). Some RDTs for HIV, HCV, and T. pallidum have been evaluated in clinical studies and/or were WHO prequalified and may be used in low-threshold services. Among them are some HIV RDTs available and approved for self-testing. In addition, some HBV RDTs based on detection of HBs antigen (HBsAg) received WHO prequalification. However, false negative results may occur in samples with low HBsAg levels, as for instance in HIV-coinfected patients receiving antiretroviral therapy. For Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), antigen-based RDTs still do not allow reliable detection of infection. Only PCR-based CT/NG RDTs possess sufficient diagnostic accuracy to be used as point-of-care tests. Rapid PCR tests for NG, however, do not provide any information about antimicrobial resistance.
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Zhang Y, Zhang P, Chen L, Kaushik A, Hu K, Wang TH. ddRFC: A scalable multiplexed droplet digital nucleic acid amplification test platform. Biosens Bioelectron 2020; 167:112499. [PMID: 32846271 DOI: 10.1016/j.bios.2020.112499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 01/24/2023]
Abstract
Digital nucleic acid amplification tests (digital NAATs) have emerged as a popular tool for nucleic acid detection due to their high sensitivity and specificity. Most current digital NAAT platforms, however, are limited to a "one-color-one-target" approach wherein each target is encoded with a specific fluorescently-labeled probe for single-plex fluorometric detection. This approach is difficult to multiplex due to spectral overlap between any additional fluorophores, and multiplexability of digital NAATs has therefore been limited. As a means to scale multiplexability, we have developed a multiplexed digital NAAT platform, termed Droplet Digital Ratiometric Fluorescence Coding (ddRFC), via a padlock probe-based nucleic acid detection assay which encodes each nucleic acid target with a unique combination of 2 fluorophores. We detect this encoded two-color fluorescence signature of each target by performing digital amplification in microfluidic droplets. To demonstrate the utility of our platform, we have synthesized 6 distinct padlock probes, each rendering a unique two-color fluorescence signature to a nucleic acid target representing a clinically important sexually transmitted infection (STI). We proceed to demonstrate broad-based, two-plex, four-plex, and six-plex detection of the STI targets with single-molecule resolution. Our design offers a cost-effective approach to scale up multiplexability by simply tuning the number of molecular beacon binding sites on the padlock probe without redesigning amplification primers or fluorescent molecular beacons. With further development, our platform has the potential to enable highly multiplexed detection of nucleic acid targets, with potentially unrestricted multiplexability, and serve as a diagnostic tool for many more diseases in the future.
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Affiliation(s)
- Ye Zhang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Pengfei Zhang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Liben Chen
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Aniruddha Kaushik
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Katherine Hu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Tza-Huei Wang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA; Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA; Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, 21218, USA.
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Gona PN, Gona CM, Ballout S, Rao SR, Kimokoti R, Mapoma CC, Mokdad AH. Burden and changes in HIV/AIDS morbidity and mortality in Southern Africa Development Community Countries, 1990-2017. BMC Public Health 2020; 20:867. [PMID: 32503604 PMCID: PMC7274054 DOI: 10.1186/s12889-020-08988-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 05/26/2020] [Indexed: 12/20/2022] Open
Abstract
Background The 16 Southern Africa Development Community (SADC) countries remain the epicentre of the HIV/AIDS epidemic with the largest number of people living with HIV/AIDS. Anti-retroviral treatment (ART) has improved survival and prevention of mother-to-child transmission (PMTCT) of HIV, but the disease remains a serious cause of mortality. We conducted a descriptive epidemiological analysis of HIV/AIDS burden for the 16 SADC countries using secondary data from the Global Burden of Diseases, Injuries and Risk Factor (GBD) Study. Methods The GBD study is a systematic, scientific effort by the Institute for Health Metrics and Evaluation (IHME) to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geographies for specific points in time. We analyzed the following outcomes: mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to HIV/AIDS for SADC. Input data for GBD was extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service utilisation, disease notifications, and other sources. Country- and cause-specific HIV/AIDS-related death rates were calculated using the Cause of Death Ensemble model (CODEm) and spatiotemporal Gaussian process regression (ST-GPR). Deaths were multiplied by standard life expectancy at each age-group to calculate YLLs. Cause-specific mortality was estimated using a Bayesian meta-regression modelling tool, DisMod-MR. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases to calculate YLDs. Crude and age-adjusted rates per 100,000 population and changes between 1990 and 2017 were determined for each country. Results In 2017, HIV/AIDS caused 336,175 deaths overall in SADC countries, and more than 20 million DALYs. This corresponds to a 3-fold increase from 113,631 deaths (6,915,170 DALYs) in 1990. The five leading countries with the proportion of deaths attributable to HIV/AIDS in 2017 were Botswana at the top with 28.7% (95% UI; 23.7–35.2), followed by South Africa 28.5% (25.8–31.6), Lesotho, 25.1% (21.2–30.4), eSwatini 24.8% (21.3–28.6), and Mozambique 24.2% (20.6–29.3). The five countries had relative attributable deaths that were at least 14 times greater than the global burden of 1.7% (1.6–1.8). Similar patterns were observed with YLDs, YLLs, and DALYs. Comoros, Seychelles and Mauritius were on the lower end, with attributable proportions less than 1%, below the global proportion. Conclusions Great progress in reducing HIV/AIDS burden has been achieved since the peak but more needs to be done. The post-2005 decline is attributed to PMTCT of HIV, resources provided through the US President’s Emergency Plan For AIDS Relief (PEPFAR), and behavioural change. The five countries with the highest burden of HIV/AIDS as measured by proportion of death attributed to HIV/AIDS and age-standardized mortaility rate were Botswana, South Africa, Lesotho, eSwatini, and Mozambique. SADC countries should cooperate, work with donors, and embrace the UN Fast-Track approach, which calls for frontloading investment from domestic or other sources to prevent and treat HIV/AIDS. Robust tracking, testing, and early treatment are required, as well as refinement of individual treatment strategies for transient individuals in the region.
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Affiliation(s)
- Philimon N Gona
- College of Nursing & Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA.
| | - Clara M Gona
- Department of Nursing, MGH Institute for Health Professions, Boston, MA, USA
| | - Suha Ballout
- College of Nursing & Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
| | - Sowmya R Rao
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Ruth Kimokoti
- Department of Nutrition, Simmons College, Boston, MA, USA
| | - Chabila C Mapoma
- Department of Population Studies, University of Zambia, Lusaka, Zambia
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Baker C, Limato R, Tumbelaka P, Rewari BB, Nasir S, Ahmed R, Taegtmeyer M. Antenatal testing for anaemia, HIV and syphilis in Indonesia - a health systems analysis of low coverage. BMC Pregnancy Childbirth 2020; 20:326. [PMID: 32471383 PMCID: PMC7257553 DOI: 10.1186/s12884-020-02993-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adverse pregnancy outcomes can be prevented through the early detection and treatment of anaemia, HIV and syphilis during the antenatal period. Rates of testing for anaemia, HIV and syphilis among women attending antenatal services in Indonesia are low, despite its mandate in national guidelines and international policy. METHODS Midwife-held antenatal care records for 2015 from 8 villages in 2 sub-districts within Cianjur district were reviewed, alongside the available sub-district Puskesmas (Community Health Centre) maternity and laboratory records. We conducted four focus group discussions with kaders (community health workers) (n = 16) and midwives (n = 9), and 13 semi-structured interviews with laboratory and counselling, public sector maternity and HIV management and relevant non-governmental organisation staff. Participants were recruited from village, sub-district, district and national level as relevant to role. RESULTS We were unable to find a single recorded result of antenatal testing for HIV, syphilis or anaemia in the village (566 women) or Puskesmas records (2816 women) for 2015. Laboratory records did not specifically identify antenatal women. Participants described conducting and reporting testing in a largely ad hoc manner; relying on referral to health facilities based on clinical suspicion or separate non-maternity voluntary counselling and testing programs. Participants recognized significant systematic challenges with key differences between the more acceptable (and reportedly more often implemented) haemoglobin testing and the less acceptable (and barely implemented) HIV and syphilis testing. However, a clear need for leadership and accountability emerged as an important factor for prioritizing antenatal testing and addressing these testing gaps. CONCLUSIONS Practical solutions such as revised registers, availability of point-of-care tests and capacity building of field staff will therefore need to be accompanied by both funding and political will to coordinate, prioritize and be accountable for testing in pregnancy.
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Affiliation(s)
- C Baker
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - R Limato
- Eijkman Institute for Molecular Biology, Jl. Diponegoro No. 69, Jakarta, 10430, Indonesia
| | - P Tumbelaka
- Eijkman Institute for Molecular Biology, Jl. Diponegoro No. 69, Jakarta, 10430, Indonesia
| | - B B Rewari
- Division of Communicable Disease, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - S Nasir
- Faculty of Public Health, Universitas Hasanuddin, Makassar, Indonesia
| | - R Ahmed
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.,Eijkman Institute for Molecular Biology, Jl. Diponegoro No. 69, Jakarta, 10430, Indonesia
| | - M Taegtmeyer
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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Toskin I, Govender V, Blondeel K, Murtagh M, Unemo M, Zemouri C, Peeling RW, Kiarie J. Call to action for health systems integration of point-of-care testing to mitigate the transmission and burden of sexually transmitted infections. Sex Transm Infect 2020; 96:342-347. [PMID: 32241905 PMCID: PMC7402556 DOI: 10.1136/sextrans-2019-054358] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/25/2020] [Accepted: 02/19/2020] [Indexed: 12/05/2022] Open
Abstract
Objectives In 2016, WHO estimated 376 million new cases of the four main curable STIs: gonorrhoea, chlamydia, trichomoniasis and syphilis. Further, an estimated 290 million women are infected with human papillomavirus. STIs may lead to severe reproductive health sequelae. Low-income and middle-income countries carry the highest global burden of STIs. A large proportion of urogenital and the vast majority of extragenital non-viral STI cases are asymptomatic. Screening key populations and early and accurate diagnosis are important to provide correct treatment and to control the spread of STIs. This article paints a picture of the state of technology of STI point-of-care testing (POCT) and its implications for health system integration. Methods The material for the STI POCT landscape was gathered from publicly available information, published and unpublished reports and prospectuses, and interviews with developers and manufacturers. Results The development of STI POCT is moving rapidly, and there are much more tests in the pipeline than in 2014, when the first STI POCT landscape analysis was published on the website of WHO. Several of the available tests need to be evaluated independently both in the laboratory and, of particular importance, in different points of care. Conclusion This article reiterates the importance of accurate, rapid and affordable POCT to reach universal health coverage. While highlighting the rapid technical advances in this area, we argue that insufficient attention is being paid to health systems capacity and conditions to ensure the swift and rapid integration of current and future STI POCT. Unless the complexity of health systems, including context, institutions, adoption systems and problem perception, are recognised and mapped, simplistic approaches to policy design and programme implementation will result in poor realisation of intended outcomes and impact.
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Affiliation(s)
- Igor Toskin
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Veloshnee Govender
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Rosanna W Peeling
- International Diagnostics Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - James Kiarie
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
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Abstract
PURPOSE OF REVIEW This study aims to review the epidemiology of sexually transmitted infections (STIs) among men who have sex with men (MSM) and suggest control measures. RECENT FINDINGS Despite declines in new HIV diagnosis, bacterial STIs among MSM have dramatically risen since the late 1990s. This increase occurred concurrent with introduction of effective antiretroviral therapy, the advent of electronic mechanisms for meeting sex partners and population-level changes in sexual behavior, including decreased condom use. HIV pre-exposure prophylaxis (PrEP) is now further diminishing condom use, though its impact on STIs is uncertain. A plan to confront the MSM STI epidemic should include increased HIV/STI testing promoted through expanded public health clinical infrastructure, health care system reform to improve the care of gender and sexual minorities and promote low-barrier care, re-invigorated condom promotion, and scientific innovation. There is an urgent need to implement new STI control measures while continuing to expand PrEP use.
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Chen JS, Matoga M, Khan S, Jere E, Massa C, Ndalama B, Seña AC, Lancaster KE, Hosseinipour MC, Cohen MS, Miller WC, Hoffman IF. Estimating syphilis seroprevalence among patients in a sexually transmitted infections clinic in Lilongwe, Malawi. Int J STD AIDS 2020; 31:359-363. [PMID: 32075535 PMCID: PMC7953433 DOI: 10.1177/0956462420906762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The syndromic management of genital ulcer disease (GUD) misses asymptomatic syphilis cases but is widely utilized in limited resource settings without diagnostic capabilities, to ensure treatment for the most common etiologies of GUD. We used rapid serology tests for syphilis screening at a Malawian sexually transmitted infections clinic. The estimated seroprevalence was 9% and was highest among patients with genital ulcers (26%) and newly diagnosed HIV infection (19%). Rapid syphilis screening has the potential to increase syphilis detection, but accurate patient histories regarding syphilis diagnosis and prior treatment are needed.
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Affiliation(s)
- Jane S Chen
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | | - Arlene C Seña
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Mina C Hosseinipour
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Myron S Cohen
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - William C Miller
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Irving F Hoffman
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Challenges of Rapid Plasma Reagin Interpretation in Syphilis Screening in Uganda: Variability in Nontreponemal Results Between Different Laboratories. Sex Transm Dis 2019; 45:829-833. [PMID: 29944643 DOI: 10.1097/olq.0000000000000883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Syphilis is a cause of morbidity and mortality and is of particular concern in pregnancy in low-income countries because of the risks associated with maternal-fetal transmission. Ugandan national guidelines recommend a nontreponemal rapid plasma reagin (RPR) followed by treponemal testing for diagnosis of syphilis. The RPR test confirms a reactive specific treponemal test, or confirms serological "cure" with a 4-fold dilutional decrease; RPR is beset with technical and biological limitations, making accurate diagnosis and appropriate treatment problematic. The aim of this analysis was to compare performance of RPR testing in different laboratories. METHODS Stored, freeze-thawed sera from 215 participants were additionally tested for RPR and dilutional titer in 2 different reference laboratories. Discrepant results were tested at a third reference laboratory which served as a tie-breaker. Equivalence in RPR titer was defined as within 2-fold or less. All patients with reactive rapid tests were treated as per Ugandan National Guidelines. RESULTS Of 215 sera, 97 (45.1%) were RPR reactive in clinic laboratory A, 81 (37.7%) and 65 (30.2%) were RPR reactive in laboratories B and C, respectively. All reported positive in laboratory C were positive in laboratory B. Discrepant results were tested in laboratory D. χ Test was highly significant (P = <0.001) for difference between each dyad of laboratories (A and B, A and C, and B and C) RPR results. There were significant differences between RPR titers by paired t test and Wilcox rank test (P = <0.001); with up to a 3-fold difference between laboratories. Two one-sided test approach demonstrated nonequivalence. Agreement between laboratories B-D, and C-D: 48 (98.0%) of 49 and 34 (69.4%) of 49, respectively (P = <0.001). Laboratories B and D showed no significant difference and had equivalent RPR titers. Laboratories C and D had different titers (P = <0.001) and were not equivalent. CONCLUSIONS We found significant interlaboratory discrepant RPR results. A 3-fold difference in results is likely to be clinically significant and could result in undertreatment or overtreatment. These data demonstrate a key limitation of the RPR test and underline the urgent need for a more reproducible quantitative test than the current RPR for diagnosing and determining cure of syphilis.
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Wi TEC, Ndowa FJ, Ferreyra C, Kelly‐Cirino C, Taylor MM, Toskin I, Kiarie J, Santesso N, Unemo M. Diagnosing sexually transmitted infections in resource-constrained settings: challenges and ways forward. J Int AIDS Soc 2019; 22 Suppl 6:e25343. [PMID: 31468679 PMCID: PMC6715950 DOI: 10.1002/jia2.25343] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/18/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Sexually transmitted infections (STIs) remain prevalent and are increasing in several populations. Appropriate STI diagnosis is crucial to prevent the transmission and sequelae of untreated infection. We reviewed the diagnostic accuracy of syndromic case management and existing point-of-care tests (POCTs), including those in the pipeline, to diagnose STIs in resource-constrained settings. METHODS We prioritized updating the systematic review and meta-analysis of the diagnostic accuracy of vaginal discharge from 2001 to 2015 to include studies until 2018. We calculated the absolute effects of different vaginal flowcharts and the diagnostic performance of POCTs on important outcomes. We searched the peer-reviewed literature for previously conducted systematic reviews and articles from 1990 to 2018 on the diagnostic accuracy of syndromic management of vaginal and urethral discharge, genital ulcer and anorectal infections. We conducted literature reviews from 2000 to 2018 on the existing POCTs and those in the pipeline. RESULTS AND DISCUSSIONS The diagnostic accuracy of urethral discharge and genital ulcer disease syndromes is relatively adequate. Asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections limit the use of vaginal discharge and anorectal syndromes. The pooled diagnostic accuracy of vaginal syndromic case management for CT/NG is low, resulting in high numbers of overtreatment and missed treatment. The absolute effect of POCTs was reduced overtreatment and missed treatment. Findings of the reviews on syndromic case management underscored the need for low-cost and accurate POCTs for the identification, first, of CT/NG, and, second, of Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) and NG and MG resistance/susceptibility testing. Near-patient POCT molecular assays for CT/NG/TV are commercially available. The prices of these POCTs remain the barrier for uptake in resource-constrained settings. This is driving the development of lower cost solutions. CONCLUSIONS The WHO syndromic case management guidelines should be updated to raise the quality of STI management through the integration of laboratory tests. STI screening strategies are needed to address asymptomatic STIs. POCTs that are accurate, rapid, simple and affordable are urgently needed in resource-constrained settings to support the uptake of aetiological diagnosis and treatment.
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Affiliation(s)
- Teodora EC Wi
- Department of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | | | | | | | - Melanie M Taylor
- Department of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Igor Toskin
- Department of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - James Kiarie
- Department of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Nancy Santesso
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityOntarioCanada
| | - Magnus Unemo
- World Health Organization Collaborating Centre for Gonorrhoea and other STIsDepartment of Laboratory MedicineFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
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Storey A, Seghers F, Pyne-Mercier L, Peeling RW, Owiredu MN, Taylor MM. Syphilis diagnosis and treatment during antenatal care: the potential catalytic impact of the dual HIV and syphilis rapid diagnostic test. Lancet Glob Health 2019; 7:e1006-e1008. [PMID: 31303285 PMCID: PMC6759458 DOI: 10.1016/s2214-109x(19)30248-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 11/21/2022]
Affiliation(s)
- Andrew Storey
- Maternal and Neonatal Health, Clinton Health Access Initiative, Boston, MA 02127, USA.
| | - Frederic Seghers
- Maternal and Neonatal Health, Clinton Health Access Initiative, Boston, MA 02127, USA
| | - Lee Pyne-Mercier
- Maternal, Neonatal and Child Health, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Rosanna W Peeling
- International Diagnostics Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Melanie M Taylor
- Sexually Transmitted Infection Program, World Health Organization, Geneva, Switzerland; Division of Sexually Transmitted Disease Prevention, US Centers for Disease Control and Prevention, Atlanta, GA
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Bristow CC, Rivera SKV, Ramos Cordova LB, Palacios LJQ, Konda KA, Klausner JD. Dual rapid test for HIV and syphilis: A laboratory evaluation of the diagnostic accuracy of the Standard Q HIV/Syphilis Combo Test. Diagn Microbiol Infect Dis 2019; 94:30-32. [PMID: 30642721 PMCID: PMC6462422 DOI: 10.1016/j.diagmicrobio.2018.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/01/2018] [Accepted: 11/19/2018] [Indexed: 11/16/2022]
Abstract
We evaluated the Standard Q HIV/Syphilis Combo Test (SD Biosensor, South Korea), a dual rapid test using stored sera (N = 400) in a laboratory setting in Lima, Peru. The sensitivity and specificity for HIV antibody detection was 100.0% (95% CI: 98.2-100.0%) and 99.5% (95% CI: 97.2-100.0%), respectively. For treponemal antibody detection the sensitivity and specificity was 97.5% (95%CI:94.3-99.2%) and 100.0% (95%CI:98.2-100.0%), respectively.
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Affiliation(s)
- Claire C Bristow
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
| | | | | | | | - Kelika A Konda
- Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeffrey D Klausner
- Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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Ogale Y, Yeh PT, Kennedy CE, Toskin I, Narasimhan M. Self-collection of samples as an additional approach to deliver testing services for sexually transmitted infections: a systematic review and meta-analysis. BMJ Glob Health 2019; 4:e001349. [PMID: 31139454 PMCID: PMC6509609 DOI: 10.1136/bmjgh-2018-001349] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/28/2019] [Accepted: 03/30/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Self-collection of samples for diagnostic testing offers the advantages of patient autonomy, confidentiality and convenience. Despite data showing their feasibility and accuracy, there is a need to better understand how to implement such interventions for sexually transmitted infections (STIs). To support WHO guidelines on self-care interventions, we conducted a systematic review to investigate whether self-collection of samples should be made available as an additional approach to deliver STI testing services. METHODS Peer-reviewed studies were included if they compared individuals who self-collected samples for chlamydia, gonorrhoea, syphilis and/or trichomonas testing to individuals who had samples collected by clinicians on the following outcomes: uptake/frequency of STI testing, social harms/adverse events, positive yield (case finding), linkage to clinical assessment/treatment and reported sexual risk behaviour. We searched PubMed, CINAHL, LILACS and EMBASE for articles published through July 2018. Risk of bias was assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for non-RCTs. Meta-analysis was conducted using random effects models to generate pooled estimates of relative risk (RR). RESULTS Eleven studies, including five RCTs and six observational studies with a total of 202 745 participants, met inclusion criteria. Studies were conducted in Australia, Denmark and the USA. Meta-analysis found that programmes offering self-collection of samples increased overall uptake of STI testing services (RR: 2.941, 95% CI 1.188 to 7.281) and case finding (RR: 2.166, 95% CI 1.043 to 4.498). No studies reported measuring STI testing frequency, social harms/adverse events, linkage to care or sexual risk behaviour. DISCUSSION While greater diversity in study designs, outcomes and settings would strengthen the evidence base, findings from this review suggest that self-collection of STI samples could be an effective additional strategy to increase STI testing uptake. PROSPERO REGISTRATION NUMBER PROSPERO CRD42018114866.
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Affiliation(s)
- Yasmin Ogale
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Igor Toskin
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Geneve, Switzerland
| | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Geneve, Switzerland
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Stafylis C, Bristow CC, Natoli LJ, Salow KR, Davidson E, Granados Y, McGrath M, Klausner JD. Field evaluation of a dual rapid Human Immunodeficiency Virus and treponemal syphilis rapid test in community-based clinics in Los Angeles and New York. Diagn Microbiol Infect Dis 2019; 93:325-328. [PMID: 30704779 PMCID: PMC7643540 DOI: 10.1016/j.diagmicrobio.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/09/2018] [Accepted: 10/03/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Dual human immunodeficiency virus/syphilis rapid diagnostic devices can play an important role in prevention efforts. The field performance of the INSTI Multiplex HIV-1/HIV-2/Syphilis Antibody Test (Multiplex) was evaluated. METHODS Fingerstick whole blood was tested using the rapid test. A fourth-generation HIV laboratory assay and treponemal-specific laboratory assays were used as reference. Rapid plasma reagin (RPR) was used to stratify treponemal results. Sensitivity and specificity were calculated. RESULTS Overall, 274 patients participated. Sensitivity of the Multiplex for detection of HIV was 98.8% (95% CI, 93.4-100%), and specificity was 100% (95% CI, 98.1-100%). Sensitivity for detection of syphilis antibodies was 56.8% (95% CI, 44.7-68.2%), and specificity was 98.5% (95% CI, 95.7-99.7%). Sensitivity for treponemal antibodies improved with increasing RPR and was 100% (95% CI, 78.2-100%) among samples with RPR titers ≥1:8. CONCLUSIONS The Multiplex showed excellent performance for detection of HIV antibodies and increasing sensitivity for detection of treponemal antibody with increasing RPR titer.
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Affiliation(s)
| | - Claire C Bristow
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Dr 0507, La Jolla, CA 92093, USA
| | - Lauren J Natoli
- AIDS Healthcare Foundation, 1811 N Western Ave, Los Angeles, CA, 90027, USA
| | - Katheryn R Salow
- AIDS Healthcare Foundation, 1811 N Western Ave, Los Angeles, CA, 90027, USA
| | - Emma Davidson
- AIDS Healthcare Foundation, 1811 N Western Ave, Los Angeles, CA, 90027, USA
| | - Yancy Granados
- AIDS Healthcare Foundation, 1811 N Western Ave, Los Angeles, CA, 90027, USA
| | - Mark McGrath
- AIDS Healthcare Foundation, 1811 N Western Ave, Los Angeles, CA, 90027, USA
| | - Jeffrey D Klausner
- David Geffen School of Medicine at UCLA, 10920 Wilshire Blvd, Los Angeles, CA, 90024, USA
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Althabe F, Chomba E, Tshefu AK, Banda E, Belizán M, Bergel E, Berrueta M, Bertrand J, Bose C, Cafferata ML, Carlo WA, Ciganda A, Donnay F, García Elorrio E, Gibbons L, Klein K, Liljestrand J, Lusamba PD, Mavila AK, Mazzoni A, Nkamba DM, Mwanakalanga FH, Mwapule Tembo A, Mwenechanya M, Pyne-Mercier L, Spira C, Wetshikoy JD, Xiong X, Buekens P. A multifaceted intervention to improve syphilis screening and treatment in pregnant women in Kinshasa, Democratic Republic of the Congo and in Lusaka, Zambia: a cluster randomised controlled trial. LANCET GLOBAL HEALTH 2019; 7:e655-e663. [PMID: 30910531 PMCID: PMC6465956 DOI: 10.1016/s2214-109x(19)30075-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/19/2018] [Accepted: 01/16/2019] [Indexed: 11/11/2022]
Abstract
Background Despite international recommendations, coverage of syphilis testing in pregnant women and treatment of those found seropositive remains limited in sub-Saharan Africa. We assessed whether combining the provision of supplies with a behavioural intervention was more effective than providing supplies only, to improve syphilis screening and treatment during antenatal care. Methods In this 18-month, cluster randomised controlled trial, we randomly assigned (1:1) 26 urban antenatal care clinics in Kinshasa, Democratic Republic of the Congo, and Lusaka, Zambia, to receive a behavioural intervention (opinion leader selection, academic detailing visits, reminders, audits and feedback, and supportive supervision) plus supplies for syphilis testing and treatment (intervention group) or to receive supplies only (control group). The primary outcomes were proportion of pregnant women who had syphilis screening out of the total who attended the clinic; and the proportion of women who had treatment with benzathine benzylpenicillin out of those who tested positive for syphilis at their first antenatal care visit. This trial is registered at ClinicalTrials.gov, number NCT02353117. Findings The 18-month study period was Feb 1, 2016, to July 14, 2017. 18 357 women were enrolled at the 13 intervention clinics and 17 679 women were enrolled at the 13 control clinics at their first antenatal care visit. Syphilis screening was done in a median of 99·9% (IQR 99·0–100·0) of women in the intervention clinics and 93·8% (85·0–98·9) in the control clinics (absolute difference 6·1% [95% CI 1·1–14·1]; p=0·00092). Syphilis treatment at the first visit was done in a median of 100% (IQR 99·7–100·0) of seropositive women in intervention clinics and 43·2% (2·6–83·2) of seropositive women in control clinics (absolute difference 56·8% [12·8–99·0]; p=0·0028). Interpretation A behavioural intervention, together with the provision of supplies, can lead to more than 95% of women being screened and treated for syphilis. The sole provision of supplies is sufficient to reach such levels of screening coverage but is not sufficient to ensure high levels of treatment. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Fernando Althabe
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina; UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Elwyn Chomba
- University Teaching Hospital of Lusaka, Lusaka, Zambia
| | - Antoinette K Tshefu
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ernest Banda
- University Teaching Hospital of Lusaka, Lusaka, Zambia
| | - María Belizán
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Eduardo Bergel
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Mabel Berrueta
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
| | - Jane Bertrand
- Tulane University School of Public Health and Tropical Medicine, Los Angeles, CA, USA
| | - Carl Bose
- University of North Carolina (UNC) School of Medicine, UNC Hospitals, Chapel Hill, NC, USA
| | | | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alvaro Ciganda
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - France Donnay
- Tulane University School of Public Health and Tropical Medicine, Los Angeles, CA, USA
| | | | - Luz Gibbons
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Karen Klein
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Paul D Lusamba
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Arlette K Mavila
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Agustina Mazzoni
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Dalau M Nkamba
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | | | | | - Cintia Spira
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jean D Wetshikoy
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, Los Angeles, CA, USA
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, Los Angeles, CA, USA
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Laboratory evaluation of four HIV/syphilis rapid diagnostic tests. BMC Infect Dis 2019; 19:1. [PMID: 30606108 PMCID: PMC6318958 DOI: 10.1186/s12879-018-3567-x] [Citation(s) in RCA: 188] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 11/29/2018] [Indexed: 11/22/2022] Open
Abstract
Background Sexually transmitted infections, such as HIV and syphilis, are one of the major health care problems worldwide, especially in low- and middle income countries. HIV screening programmes have been widely used for many years. The introduction of rapid point-of-care tests (RDTs) that can detect both HIV and syphilis, using one single blood specimen, would be a promising tool to integrate the detection of syphilis into HIV programmes and so improve the accessibility of syphilis testing and treatment. Methods As part of the World Health Organization pre-qualification of in vitro diagnostics assessment, the laboratory performance of four dual HIV-Syphilis rapid diagnostic tests (SD Bioline HIV/Syphilis Duo, DPP HIV-Syphilis Assay, Multiplo Rapid TP/HIV Antibody Test and Insti Multiplex HIV-1/HIV-2/Syphilis Antibody Test) was assessed using a well characterized multiregional panel of stored sera specimens. Results In total 400 specimens were tested with each assay, resulting in excellent sensitivities and specificities for HIV, ranging from 99.5 to 100% and from 93.5 to 99.5%, respectively. Results obtained for the Treponema pallidum antibodies were lower, with the lowest sensitivity of 73.5% for Multiplo and the highest of 87% for SD Bioline. Specificities ranged from 99.0 to 100%. Conclusion Although these results suggest that the tests could further improve in accuracy in detection of treponemal antibodies, their introduction into screening programmes to increase the accessibility of HIV/Syphilis diagnosis and treatment for difficult to reach populations in the world is promising.
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REASSURED diagnostics to inform disease control strategies, strengthen health systems and improve patient outcomes. Nat Microbiol 2018; 4:46-54. [PMID: 30546093 PMCID: PMC7097043 DOI: 10.1038/s41564-018-0295-3] [Citation(s) in RCA: 398] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 10/18/2018] [Indexed: 01/27/2023]
Abstract
Lack of access to quality diagnostics remains a major contributor to health burden in resource-limited settings. It has been more than 10 years since ASSURED (affordable, sensitive, specific, user-friendly, rapid, equipment-free, delivered) was coined to describe the ideal test to meet the needs of the developing world. Since its initial publication, technological innovations have led to the development of diagnostics that address the ASSURED criteria, but challenges remain. From this perspective, we assess factors contributing to the success and failure of ASSURED diagnostics, lessons learnt in the implementation of ASSURED tests over the past decade, and highlight additional conditions that should be considered in addressing point-of-care needs. With rapid advances in digital technology and mobile health (m-health), future diagnostics should incorporate these elements to give us REASSURED diagnostic systems that can inform disease control strategies in real-time, strengthen the efficiency of health care systems and improve patient outcomes.
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Kasaro MP, Bosomprah S, Taylor MM, Sindano N, Phiri C, Tambatamba B, Malumo S, Freeman B, Chibwe B, Laverty M, Owiredu MN, Newman L, Sikazwe I. Field performance evaluation of dual rapid HIV and syphilis tests in three antenatal care clinics in Zambia. Int J STD AIDS 2018; 30:323-328. [PMID: 30472926 DOI: 10.1177/0956462418800872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This cross-sectional study of 3212 pregnant women assessed the field performance, acceptability, and feasibility of two dual HIV/syphilis rapid diagnostic tests, the Chembio DPP HIV-syphilis Assay and the SD Bioline HIV/syphilis Duo in antenatal clinics. Sensitivity and specificity for HIV and syphilis were calculated compared to the rapid Determine HIV-1/2 with Uni-Gold to confirm positive results for HIV and the Treponema pallidum particle agglutination assay for syphilis. RPR titers ≥1:4 were used to define active syphilis detection. Acceptability and feasibility were assessed using self-reported questionnaires. For Chembio, the HIV sensitivity was 90.6% (95%CI = 87.4, 93.0) and specificity was 97.2% (95%CI = 96.2, 97.8); syphilis sensitivity was 68.6% (95%CI = 61.9, 74.6) and specificity was 98.5% (95%CI = 97.8, 98.9). For SD Bioline, HIV sensitivity was 89.4% (95%CI = 86.1, 92.0) and specificity was 96.3% (95%CI = 95.3, 97.1); syphilis sensitivity was 66.2% (95%CI = 59.4, 72.4) and specificity was 97.2% (95%CI = 96.4, 97.9). Using the reference for active syphilis, syphilis sensitivity was 84.7% (95%CI = 76.1, 90.6) for Chembio and 81.6% (95%CI = 72.7, 88.1) for SD Bioline. Both rapid diagnostic tests were assessed as highly acceptable and feasible. In a field setting, the performance of both rapid diagnostic tests was comparable to other published field evaluations and each was rated highly acceptable and feasible. These findings can be used to guide further research and proposed scale up in antenatal clinic settings.
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Affiliation(s)
| | - Samuel Bosomprah
- 1 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,2 Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Melanie M Taylor
- 3 Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,4 Division of STD Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ntazana Sindano
- 1 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Caroline Phiri
- 5 Ministry of Community Development, Mother and Child Health, Lusaka, Zambia
| | | | - Sarai Malumo
- 6 World Health Organization Country Office, Lusaka, Zambia
| | - Bethany Freeman
- 1 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Bertha Chibwe
- 1 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Maura Laverty
- 3 Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Morkor N Owiredu
- 7 World Health Organization, Intercountry Support Team for East and Southern Africa, Harare, Zimbabwe
| | - Lori Newman
- 8 Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Phnom Penh, Cambodia
| | - Izukanji Sikazwe
- 1 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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Taylor MM, Kamb M, Wu D, Hawkes S. Syphilis screening and treatment: integration with HIV services. Bull World Health Organ 2018; 95:610-610A. [PMID: 28867837 PMCID: PMC5578388 DOI: 10.2471/blt.17.200923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Melanie M Taylor
- Department of Reproductive Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Mary Kamb
- Division of Sexually Transmitted Diseases Prevention, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Dadong Wu
- Institute for Global Health, University College London, London, England
| | - Sarah Hawkes
- Institute for Global Health, University College London, London, England
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Wang Q, Chan PL, Newman LM, Dou LX, Wang XY, Qiao YP, Su M, Chen XS, Jin X, Wang AL. Acceptability and feasibility of dual HIV and syphilis point-of-care testing for early detection of infection among pregnant women in China: a prospective study. BMJ Open 2018; 8:e020717. [PMID: 30366912 PMCID: PMC6224742 DOI: 10.1136/bmjopen-2017-020717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 07/28/2018] [Accepted: 08/08/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the feasibility and acceptability of using WHO prequalified combined dual HIV/syphilis rapid diagnostic tests (RDT) for same-day results in antenatal care (ANC) clinics. METHODS This is a pragmatic implementation study using quantitative approach to evaluate outcomes. Antenatal clinic attendees from 21 rural and urban township hospitals in two provinces of China were offered with free dual RDTs testing that included HIV and syphilis, in addition to the routine blood tests. Study outcomes included testing uptake before and during dual RDT use, test feasibility and acceptability among pregnant women. Regression model was used to assess acceptance of RDT testing. RESULTS In total, 1787 out of 1828 pregnant women attending ANC received the RDT testing. Testing uptake among pregnant women in their first and second trimester increased from 76.0% (2438/3269) using standard blood testing to 90.1% (1626/1787) with concurrent RDT use (χ2=197.1, p<0.001). Among 1787 pregnant women who received RDT tests, 98.3% (1757/1787) participants were given test result the same day. Positive proportions of HIV and syphilis screened with RDT were 0.06% (1/1787) and 1.0% (18/1787), respectively. Regression analysis indicated that women who did not receive syphilis or HIV testing before were less likely to accept dual RDT (OR 0.28, 95% CI 0.10 to 0.75). Acceptance for dual RDT testing at second or third antenatal visit was lower compared with the first visit (OR 0.37, 95% CI 0.15 to 0.94). CONCLUSION Combined dual HIV/syphilis RDT with same-day results increased uptake of HIV and syphilis testing among pregnant women at primary healthcare facilities. Given the diversity of testing capacities among health services especially in rural areas in China, the dual RDT kit is feasible tool to improve testing uptake among pregnant women.
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Affiliation(s)
- Qian Wang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Po-Lin Chan
- Division of Communicable Diseases, World Health Orgnization China Office, Beijing, China
| | - Lori M Newman
- Department of Reproductive Health Research, World Health Organization, Geneva, Swaziland
| | - Li-Xia Dou
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiao-Yan Wang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ya-Ping Qiao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Min Su
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiang-Sheng Chen
- National Center for Sexually Transmitted Disease Control, Chinese Academy of Medical Science and Peking Union Medical College Institute of Dermatology, Nanjing, China
| | - Xi Jin
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ai-Ling Wang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
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Withers K, Bristow C, Nguyen M, Stafylis C, Giang LM, Klausner JD. A field evaluation of a rapid dual immunoassay for human immunodeficiency virus and syphilis antibodies, Hanoi, Vietnam. Int J STD AIDS 2018; 30:173-180. [PMID: 30348065 DOI: 10.1177/0956462418802685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The SD BIOLINE HIV/Syphilis Duo (SD BIOLINE DUO) rapid test is a dual rapid lateral flow immunoassay that detects antibodies to both human immunodeficiency virus (HIV) and Treponema pallidum (TP) 'syphilis' via fingerprick whole blood. We evaluated the field performance of the SD BIOLINE HIV/Syphilis Duo test among two populations in Hanoi, Vietnam - men who have sex with men (MSM) and pregnant women. We also surveyed factors that influence participants' willingness to test for HIV and syphilis. This test has the potential to increase HIV and syphilis screening in low-resource settings. Patients who received healthcare services at a sexual health clinic for MSM and a district antenatal care center in Hanoi, Vietnam were recruited for the study. Participants with HIV and syphilis were intentionally recruited for adequate test performance evaluation via convenience sampling. At each facility, venipuncture blood specimens were obtained for reference testing for HIV and TP using SD BIOLINE HIV 1/2 3.0 and TP particle agglutination, respectively. SD BIOLINE DUO was compared to the standard reference tests and sensitivity and specificity were calculated. We calculated 95% confidence interval (CI) using the exact binomial method. We used conjoint analysis to identify test attributes that are associated with participant likelihood to seek HIV and syphilis testing. Of 280 participants, 100 (35.7%) were MSM and 180 (64.3%) were pregnant women. Of MSM, 17 (17.0%) were HIV positive and 49 (49.0%) were TP seropositive. All women were negative for both HIV and syphilis antibodies. For HIV antibody testing, sensitivity and specificity were 100.0% (95% CI: 80.5-100.0%) and 100.0% (95% CI: 98.6-100.0%), respectively. For the syphilis antibody testing, sensitivity and specificity were 83.1% (95% CI: 71.0-91.6%) and 100.0% (95% CI: 98.3-100.0%), respectively. Potential for false positives, preference for one blood draw over two, and shorter wait time for testing results were the highest ranked attributes by participants according to their willingness to test. The SD BIOLINE HIV/Syphilis Duo rapid test demonstrated very good performance in this field setting and participants preferred attributes that aligned well with this test.
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Affiliation(s)
- Keenan Withers
- 1 David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Clare Bristow
- 2 Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Minh Nguyen
- 3 Center for Research and Training of AIDS, Hanoi Medical University, Hanoi, Vietnam
| | - Chrysovalantis Stafylis
- 4 Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Le M Giang
- 3 Center for Research and Training of AIDS, Hanoi Medical University, Hanoi, Vietnam
| | - Jeffrey D Klausner
- 1 David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,4 Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Olugbenga I, Taiwo O, Laverty M, Ngige E, Anyaike C, Bakare R, Ogunleye V, Peterson Maddox BL, Newman DR, Gliddon HD, Ofondu E, Nurse-Findlay S, Taylor MM. Clinic-based evaluation study of the diagnostic accuracy of a dual rapid test for the screening of HIV and syphilis in pregnant women in Nigeria. PLoS One 2018; 13:e0198698. [PMID: 29990336 PMCID: PMC6038984 DOI: 10.1371/journal.pone.0198698] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/23/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Screening pregnant women for HIV and syphilis is recommended by WHO in order to reduce mother-to-child transmission. We evaluated the field performance, feasibility, and acceptability of a dual rapid diagnostic test (RDT) for HIV and syphilis test in antenatal clinic settings in Nigeria. METHODS AND FINDINGS Participants were recruited at 12 antenatal clinic sites in three states of Nigeria. All consenting individuals were tested according to the national HIV testing algorithm, as well as a dual RDT, the SD BIOLINE HIV/Syphilis Duo Test (Alere, USA), in the clinic. To determine sensitivity, specificity and concordance, whole blood samples were obtained for repeat RDT performance in the laboratory, as well as reference tests for HIV and syphilis. Dual test acceptability and operational characteristics were assessed among participants and clinic staff. The prevalence of HIV among the 4,551 enrollees was 3.0% (138/4551) using the national clinic-based HIV testing algorithm. Positive and negative percent agreement of the HIV component of the dual RDT were 100.0% (95% CI 99.7-100.0) and 99.9% (95% CI 99.7-100.0) respectively, when compared with the national rapid testing algorithm. The prevalence of syphilis, using TPHA as the reference test, was low at 0.09% (4/4550). The sensitivity of the syphilis component of the dual RDT could not be calculated as no positive results were observed for patients that were positive for syphilis by TPHA. Each of the only four TPHA-positive specimens had RPR titers of 1:1 (neat), indicative of non-active syphilis. The specificity of the syphilis component of the dual RDT was 99.9% (95% CI 99.8-100.0). The dual RDT received favorable feasibility ratings among antenatal care clinic staff. Acceptability among study participants was high with most women reporting preference for rapid dual HIV/syphilis testing. CONCLUSIONS The SD BIOLINE HIV/Syphilis Duo Test showed a high overall diagnostic accuracy for HIV and a high specificity for syphilis diagnosis in antenatal clinic settings. This study adds to a growing body of evidence that supports the clinic-based use of dual tests for HIV and syphilis among pregnant women.
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Affiliation(s)
- Ijaodola Olugbenga
- National AIDS and STIs Control Programme, Federal Ministry of Health Nigeria, FCT Abuja, Nigeria
| | | | - Maura Laverty
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Evelyn Ngige
- National AIDS and STIs Control Programme, Federal Ministry of Health Nigeria, FCT Abuja, Nigeria
| | - Chukwuma Anyaike
- National AIDS and STIs Control Programme, Federal Ministry of Health Nigeria, FCT Abuja, Nigeria
| | - Rasheed Bakare
- Department of Microbiology, University College Hospital Ibadan, Ibadan, Nigeria
| | - Veronica Ogunleye
- Department of Microbiology, University College Hospital Ibadan, Ibadan, Nigeria
| | - Brandy L. Peterson Maddox
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Daniel R. Newman
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Harriet D. Gliddon
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- London Centre for Nanotechnology, University College London, London, United Kingdom
| | - Eugenia Ofondu
- Dermatology and Venereology Department, Federal Medical Center Owerri, Owerri, Nigeria
| | - Stephen Nurse-Findlay
- 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
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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The Epidemiology of Human Immunodeficiency Virus (HIV) and Syphilis in Ghana: A Five-Year Single Urban Site Parallel Population-Based Analysis vis-à-vis the Sentinel Survey. J Trop Med 2018; 2018:6574731. [PMID: 30002681 PMCID: PMC5998162 DOI: 10.1155/2018/6574731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/02/2018] [Indexed: 11/17/2022] Open
Abstract
The study was aimed at comparing the estimation of the burden and trends (2012–2016) of Human Immunodeficiency Virus (HIV) and Syphilis infections by the national Sentinel Survey vis-à-vis the use of population-based studies at a single urban site (Municipal Hospital) in Ho, the Volta Region of Ghana. Using blood donors as a proxy of the asymptomatic adult population, a retrospective analysis of secondary data on HIV and Syphilis testing was conducted using Ho Municipal Hospital's archives comprising 4,180 prospective blood donors. Published reports from the National Sentinel Survey for the Ho Sentinel Site comprising 2,452 pregnant women from 2012 to 2016 were used. The cumulative prevalence of HIV and Syphilis infections in the population-based survey was 4.78% and 2.58% while the epidemiology was estimated at 2.75% and 0.24% by the Sentinel Survey for the five-year under review. The new HIV and Syphilis infections were 3.78% and 2.46% in the population-based survey compared to 2.64% and 0.23% in the Sentinel Survey. Gender cumulative prevalence and the yearly trend was found to be higher in the general population compared to the pregnant women. The use of pregnant women to estimate the HIV and Syphilis epidemiology might not be representative of the general population.
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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.
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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
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Amsalu A, Ferede G, Assegu D. High seroprevalence of syphilis infection among pregnant women in Yiregalem hospital southern Ethiopia. BMC Infect Dis 2018; 18:109. [PMID: 29510664 PMCID: PMC5840736 DOI: 10.1186/s12879-018-2998-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 02/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite availability of effective treatment and the implementation of focused antenatal care (ANC), still the prevalence of syphilis persists in Ethiopia. Yet, data is not found in southern Ethiopia. Therefore, this study was conducted to determine the seroprevalence and associated factors of syphilis among pregnant women in Yiregalem Hospital, Southern Ethiopia. METHODS A cross-sectional study was conducted among pregnant women from October 2015 to August 2016. Data on socio-demography and obstetric conditions of pregnant women were collected using a structured questionnaire. Serum samples were screened for syphilis using rapid plasma regain (RPR) test and those found seropositive were further confirmed by Treponema pallidum haemagglutination assay (TPHA) test following the manufacturer's instruction. HIV results were reviewed from records. The data were analyzed using SPSS version 20 software. RESULTS Of 494 pregnant women, 204(41.3%) were first ANC visit attenders. Of these, 123(60.3%) were after the 12th gestational week. Sero-prevalence of syphilis and HIV was found to be 5.1% (25/494; 95 CI, 3.2-7.1%) and 10.3% (51/494; 95 CI, 7.7-13.2%), respectively. The overall prevalence of syphilis and HIV co-infection was 2.2% (11/494). Women with HIV infection were significantly more likely to be syphilis-seropositive (AOR = 10.3, 95%CI, 4.213-25.185) than HIV negatives. CONCLUSIONS High seroprevalence of syphilis particularly among HIV positive women and late first ANC visit attenders in the study area calls for further ramping up of current intervention measures. Like integration of syphilis testing and treatment to the already established HIV prevention program and creating awareness about early ANC visit and follow-up.
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Affiliation(s)
- Anteneh Amsalu
- Department of Medical Microbiology, University of Gondar, P.O.Box 196, Gondar, Ethiopia
| | - Getachew Ferede
- Department of Medical Microbiology, University of Gondar, P.O.Box 196, Gondar, Ethiopia
| | - Demissie Assegu
- Department of Medical Laboratory Sciences, Hawassa University, Hawassa, Ethiopia
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Abstract
PURPOSE OF REVIEW Syphilis continues to cause morbidity and mortality worldwide. While syphilis infection is easily identifiable and treatable, rates of syphilis infection continue to increase among select populations in high-income countries and remain at endemic levels in low- and middle-income counties. RECENT FINDINGS World Health Organization recommended strategies have led to the dual elimination of mother-to-child transmission of syphilis and HIV in several countries, however outbreaks among select populations need to be adequately addressed. SUMMARY Continued vigilance and investment is needed to address syphilis worldwide. The epidemiology of syphilis differs in high-income and low- and middle-income counties.
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Affiliation(s)
- Noah Kojima
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, 90095
| | - Jeffrey D Klausner
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, 90095
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, 90024
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Taylor M, Gliddon H, Nurse-Findlay S, Laverty M, Broutet N, Pyne-Mercier L, Liljestrand J. Revisiting strategies to eliminate mother-to-child transmission of syphilis. Lancet Glob Health 2018; 6:e26-e28. [PMID: 29241606 PMCID: PMC6747700 DOI: 10.1016/s2214-109x(17)30422-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/13/2017] [Indexed: 10/30/2022]
Affiliation(s)
- Melanie Taylor
- WHO Department of Reproductive Health and Research, STI Program, Geneva 1211, Switzerland; US Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA, USA.
| | - Harriet Gliddon
- London Centre for Nanotechnology, University College London, London, UK
| | - Stephen Nurse-Findlay
- WHO Department of Reproductive Health and Research, STI Program, Geneva 1211, Switzerland
| | - Maura Laverty
- WHO Department of Reproductive Health and Research, STI Program, Geneva 1211, Switzerland
| | - Nathalie Broutet
- WHO Department of Reproductive Health and Research, STI Program, Geneva 1211, Switzerland
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Grebely J, Applegate TL, Cunningham P, Feld JJ. Hepatitis C point-of-care diagnostics: in search of a single visit diagnosis. Expert Rev Mol Diagn 2017; 17:1109-1115. [DOI: 10.1080/14737159.2017.1400385] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jason Grebely
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Tanya L. Applegate
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Philip Cunningham
- St Vincent’s Centre for Applied Medical Research, Darlinghurst, Sydney, Australia
| | - Jordan J. Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Canada
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Taylor MM, Peeling RW, Toskin I, Ghinidelli M. Role of dual HIV/syphilis test kits in expanding syphilis screening. Sex Transm Infect 2017; 93:458-459. [PMID: 28778981 PMCID: PMC6748393 DOI: 10.1136/sextrans-2017-053301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/03/2017] [Indexed: 11/04/2022] Open
Affiliation(s)
- Melanie M Taylor
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Department of STD Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rosanna W Peeling
- International Diagnostics Centre, London School of Tropical Medicine and Hygiene, London, UK
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Massimo Ghinidelli
- International Diagnostics Centre, Pan American Health Organization, Washington, District of Columbia, USA
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