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Hutton-Nyameaye AA, Asiamah M, Asafo-Adjei K, Benneh CK, Kwakye AO, Mensah KB, Duedu KO, Buabeng KO. Knowledge and prevalence of common sexually transmitted infections among patients seeking care at selected health facilities in Southern Ghana. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003422. [PMID: 38950047 PMCID: PMC11216559 DOI: 10.1371/journal.pgph.0003422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 06/06/2024] [Indexed: 07/03/2024]
Abstract
The burden of Sexually transmitted infections (STIs) remains a public health problem that should be addressed considering its effect on society and close association with HIV. This study aimed to determine the knowledge and prevalence of common STIs and associated risk factors among adult patients seeking STI care in health facilities in Ho Municipality. This was an analytical cross-sectional study involving 178 adult clients seeking treatment for suspected STIs, from November 2020 to April 2021. Data on participants' demographic characteristics, knowledge and health-seeking behaviour for STI therapy was obtained. Urine and blood samples were also taken from each participant for microbiological screening to identify the infecting pathogen and the specific STI. Multiple logistic regression and chi-square analyses were used to test the significance of associations. Of the 178 participants, 71.91% (n = 128) were women and 61.24% (n = 109) were unmarried. About 13% (n = 23) had poor knowledge of STIs. Prevalence of the STIs was 24.72% (n = 44) of which gonorrhoea was the highest 11.24% (n = 20), followed by chlamydia 10.11% (n = 18) and syphilis 7.30% (n = 13). Of all the participants, 3.37% (n = 6) had co-infections with at least 2 pathogens. Infection with all three pathogens was observed in a single participant. Participants who were married were associated with 61% reduced odds of sexually transmitted infection compared to participants who were unmarried (AOR = 0.39; Cl = 0.17-0.89). Participants who smoked had 6.5 times increased odds of the infection compared to nonsmoking participants (AOR = 6.51; Cl = 1.07-39.56). Although knowledge of STIs was high, it did not appear to contribute to lowering of the prevalence. This suggests there may be other factors other than awareness or knowledge driving STIs. There is an urgent need for further studies to ascertain the drivers of STIs beyond knowledge and awareness in the public.
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Affiliation(s)
- Araba Ata Hutton-Nyameaye
- Faculty of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti Region, Ghana
- Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Morrison Asiamah
- Department of Electron Microscopy and Histopathology, Noguchi Memorial Institute for Medical Research, Accra, University of Ghana, Greater Accra Region, Ghana
| | | | - Charles Kwaku Benneh
- Department of Pharmacology and Toxicology, School of Pharmacy, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Adwoa Oforiwaa Kwakye
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Greater Accra Region, Ghana
| | - Kofi Boamah Mensah
- Faculty of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti Region, Ghana
| | - Kwabena Obeng Duedu
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Volta Region, Ghana
- College of Life Sciences, Birmingham City University, City South Campus, Birmingham, United Kingdom
| | - Kwame Ohene Buabeng
- Faculty of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti Region, Ghana
- Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Zeleke G, Mekonnen A, Abuhay T, Agimas MC. Proportion of early treatment seeking for sexually transmitted infections and associated factors among patients attending youth friendly service in Bahir Dar City health centers, Northwest, Ethiopia. Reprod Health 2024; 21:85. [PMID: 38879531 PMCID: PMC11179198 DOI: 10.1186/s12978-024-01794-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/15/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Sexually transmitted infection is a common public health issue of youths and is characteristically transmitted through sexual intercourse. Even though early treatment for sexually transmitted infection is very important to reduce further complications and economic burden, studies to identify the proportion and the possible factor of early treatment seeking is rare in Ethiopia. OBJECTIVE To assess the proportion of early treatment seeking for sexually transmitted infections and associated factors among patients attending youth friendly service in Bahir Dar city health centers, northwest, Ethiopia 2023. METHOD Institutional based Cross-sectional study was used among 407 participants from April 25 to May 24 /2023. A systematic random sampling technique was used to select the participants. An interview-administered questionnaire was used for data collection, whereas Epi-data version 4.6.0.2 and the statistical package for statistical science version 23 were used for data entry and analysis respectively. A frequency table and bar chart were used for descriptive analysis. Multiple binary logistic regression was employed to identify the factors at p-value of <0.05. The necessary assumption of the model was also checked by the Hosmer and Lemishow test. RESULTS The response rate of this study was 391 (96.1%) and the proportion of early treatment for sexually transmitted infection was 108 (27.6%, 95%CI; 23-32). Good knowledge about sexually transmitted infection (AOR=1.98, 95CI%; 1.13-3.47) know about their HIV status (AOR=1.95, 95%CI; 1.13-3.36), perceive severity of sexually transmitted infection (AOR=11.23, 95%CI; 6.15-20.45), and not fear the stigma about being infected with sexually transmitted infection (AOR=2.29, 95%CI; 1.32-3.96) were the significantly associated factors for early treatment of sexually transmitted infection. CONCLUSION AND RECOMMENDATION: The proportion of early treatment for sexually transmitted infection in Bahir Dar city was low. Knowledge about STIs, testing/ knowing HIV status, perception of the severity about sexually transmitted infection, and fear of stigma about sexually transmitted infection were the statistically significant factors for early treatment of sexually transmitted infection. So the government better give attention to health education and other health promotion activities to increase the knowledge of youths about sexually transmitted infection and to change their perception of sexually transmitted infection.
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Affiliation(s)
- Getachew Zeleke
- Han health center, Bahir Dar health department, Bahir Dar, Amhara region, Ethiopia
| | - Alemtshay Mekonnen
- Department of reproductive health, college of medicine and health sciences, Bahir Dar university, Bahir Dar, Bahir Dar, Ethiopia
| | - Tigist Abuhay
- Department of reproductive health, college of medicine and health sciences, Bahir Dar university, Bahir Dar, Bahir Dar, Ethiopia
| | - Muluken Chanie Agimas
- Department of Epidemiology and Biostatistics, institute of public health, college of medicine and health sciences, university of Gondar, Gondar, Ethiopia.
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Martin K, Dauya E, Simms V, Bandason T, Azizi S, Machiha A, Shamu T, Musiyandaka P, Mwaturura T, Francis SC, Mackworth-Young CRS, Busza J, Mavodza C, Tembo M, Hayes RJ, Kranzer K, Ferrand RA, Dziva Chikwari C. Risk factors for curable sexually transmitted infections among youth: findings from the STICH population survey in Zimbabwe. Sex Transm Infect 2024:sextrans-2024-056146. [PMID: 38871454 DOI: 10.1136/sextrans-2024-056146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVES Youth are at high risk of sexually transmitted infections (STIs) in Africa. We aimed to determine the risk factors for curable STIs in youth in Zimbabwe. METHODS A population-based survey was conducted among randomly selected 18-24 year-olds in 16 communities across two provinces in Zimbabwe to ascertain outcomes for a cluster randomised trial investigating the impact of community-based STI screening for youth on population prevalence of STIs. Participants underwent an interviewer-administered questionnaire, HIV testing and screening for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV). Risk factors for curable STIs were explored through multivariable logistic regression. RESULTS Of the 5601 participants, 62.5% (n=3500) were female, and the median age was 20 (IQR 19-22) years. HIV prevalence was 6.3% (351/5556), and 55.4% (1939/3501) reported condomless sex at last intercourse. Only 7.2% (401/5599) reported STI symptoms, but CT/NG/TV prevalence was 19.8% (1107/5601). On multivariable analysis, factors associated with STI diagnosis included being aged 21-24 years (adjusted OR (aOR) 1.37, 95% CI 1.17 to 1.61); female sex (aOR 2.11, 95% CI 1.76 to 2.53); being unemployed/informally employed (compared with in education/formal employment) (aOR 1.35, 95% CI 1.13 to 1.61); increasing number of sexual partners in the preceding 12 months (one partner: aOR 2.23, 95% CI 1.73 to 2.88; two partners: aOR 2.39, 95% CI 1.69 to 3.39); living with HIV (aOR 1.44, 95% CI 1.07 to 1.94); and previous attempted suicide (aOR 1.58, 95% CI 1.08 to 2.32). CONCLUSIONS The prevalence of STIs among youth in Zimbabwe is high, particularly among those with HIV. In addition to moving away from syndromic STI management and strengthening implementation of existing prevention tools, there is a need for a more holistic focus on broader risk factors such as mental health and employment opportunities, and of integration of HIV and STI programming. TRIAL REGISTRATION NUMBER ISRCTN15013425, NCT03719521.
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Affiliation(s)
- Kevin Martin
- Clinical Research Department, The London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ethel Dauya
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Victoria Simms
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, UK
| | - Tsitsi Bandason
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Steven Azizi
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, UK
| | - Anna Machiha
- AIDS and TB Unit, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Primrose Musiyandaka
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tinashe Mwaturura
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Suzanna C Francis
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, UK
| | - Constance R S Mackworth-Young
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Global Health and Development, The London School of Hygiene & Tropical Medicine, London, UK
| | - Joanna Busza
- Department of Public Health, Environments and Society, The London School of Hygiene & Tropical Medicine, London, UK
| | - Constancia Mavodza
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Public Health, Environments and Society, The London School of Hygiene & Tropical Medicine, London, UK
| | - Mandi Tembo
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, UK
| | - Richard J Hayes
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, UK
| | - Katharina Kranzer
- Clinical Research Department, The London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Rashida A Ferrand
- Clinical Research Department, The London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, UK
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Mankelkl G, Abdu SM, Asefa EM, Kassaw AB, Abebe G, Belete M, Tareke AA, Gedefie A, Kinfe B. Individual and community level factors associated with sexually transmitted infections among men in Tanzania: insights from the Tanzania demographic and health survey of 2022. BMC Infect Dis 2024; 24:580. [PMID: 38867176 PMCID: PMC11170883 DOI: 10.1186/s12879-024-09470-2] [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: 01/02/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Sexually transmitted infections continue to be a significant public health issue on a global scale. Due to their effects on reproductive and child health as well as their role in facilitating the spread of HIV infection, sexually transmitted infections impose a heavy burden of morbidity and mortality in many developing countries. In addition, stigma, infertility, cancer, and an increased risk of HIV are the primary impacts of STIs on sexual and reproductive health. While numerous studies have been conducted in Tanzania to address this specific topic in various settings, the majority of them weren't representative. Therefore, the main objective of this study was to use data from the most recent Tanzania Demographic and Health Survey in order to evaluate the individual and community-level factors associated with sexually transmitted infections among Tanzanian men at the national level. METHODS The most recent datasets from the Tanzania demographic and health survey were used for secondary data analysis. A total of 5763 men participated in this study. The recent Tanzania demographic and health survey provides data for multilevel mixed effect analysis on the variables that contribute to sexually transmitted infections among men in Tanzania. Finally, the percentage and odd ratio were provided, together with their 95% confidence intervals. RESULT This study includes a total weighted sample of 5763 men from the Tanzania demographic and health survey. Of the total study participants, 7.5% of men had sexually transmitted infections in the last twelve months. Being married [AOR: 0.531, 95% CI (0.9014, 3.429)] was a factor that reduced the risk of sexually transmitted infections among men. On the other hand, being between the age range of 20 and 24 years [AOR: 6.310, 95% CI (3.514, 11.329)] and having more than one union [AOR: 1.861, 95% CI (1.406, 2.463)] were the factors that increased the risk of sexually transmitted infections among men. CONCLUSIONS Men's sexually transmitted infections have been associated with individual-level factors. So, the Tanzanian governments and the concerned stakeholders should provide special attention for men whose age range is 20-24 years old. Promoting marriages and limiting the number of sexual partners should be the main strategies to lower the risk of sexually transmitted infections among men in Tanzania.
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Affiliation(s)
- Gosa Mankelkl
- Department of Biomedical Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
| | - Seid Mohammed Abdu
- Department of Biomedical Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Ebrahim Msaye Asefa
- Department of Biomedical Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Altaseb Beyene Kassaw
- Department of Biomedical Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Gashawu Abebe
- Department of Biomedical Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Mekonnen Belete
- Department of Biomedical Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Amare Abera Tareke
- Department of Biomedical Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Beletu Kinfe
- Department of occupational Health and safety, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Tsorou C, Williams A, van den Boogaard W, Staderini N, Repetto E, Terzidis A, Pikoulis E. Point-of-care diagnostics for sexually transmitted infections among migrants in Greece. Public Health Action 2024; 14:14-19. [PMID: 38798779 PMCID: PMC11122709 DOI: 10.5588/pha.23.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/06/2023] [Indexed: 05/29/2024] Open
Abstract
SETTING Sexually transmitted infections (STIs) can impact individuals of any demographic. The most common pathogens causing STIs are Chlamydia trachomatis, Neisseria gonorrhea and Trichomonas vaginalis; these can be treated with specific antibiotics. OBJECTIVE To compare the GeneXpert CT/NG test-and-treat algorithm to the syndromic approach algorithm and their impact on antibiotic prescription for gonorrhoea and chlamydia STIs. DESIGN A retrospective observational study on women aged ≥18 years who accessed the Médecins Sans Frontières Day Care Centre in Athens with complaints related to urogenital infections between January 2021 and March 2022. Women with abnormal vaginal discharge, excluding clinically diagnosed candidiasis, were eligible for Xpert CT/NG testing. RESULTS Of the 450 women who accessed care, 84 were eligible for Xpert CT/NG testing, and only one was positive for chlamydia, therefore resulting in saving 81 doses of ceftriaxone and azithromycin, and 19 doses of metronidazole. The cost of Xpert CT/NG testing, including treatment was €4,606.37, while full antibiotic treatment would have costed €536.76. CONCLUSION The overall cost of the Xpert CT/NG test-and-treat algorithm was higher than the syndromic approach. However, quality of care should be weighed against the potential benefits of testing and syndromic treatment to determine the best option for each patient; we therefore advocate for decreasing the costs.
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Affiliation(s)
- C Tsorou
- Médecins Sans Frontières (MSF), Operational Centre Geneva, Mission Greece, Athens
- Disaster Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Williams
- MSF, Luxembourg Operational Research (LuxOR) Unit, Operational Centre Brussels, Brussels
- MSF, Middle East Medical Unit (MEMU), Operational Centre Brussels, Belgium
| | - W van den Boogaard
- MSF, Luxembourg Operational Research (LuxOR) Unit, Operational Centre Brussels, Brussels
| | - N Staderini
- MSF, Operational Centre Geneva Medical Department, Geneva, Switzerland
| | - E Repetto
- MSF, Operational Centre Geneva Medical Department, Geneva, Switzerland
- Infectious Diseases Unit, Saint Pierre University Hospital, Brussels, Belgium
| | - A Terzidis
- Disaster Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - E Pikoulis
- Disaster Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Moodley C, Tootla H, Amien I, Engel ME. Evaluating the utility of the Allplex STI Essential Assay to determine the occurrence of urogenital sexually transmitted infections among symptomatic and asymptomatic patients in Cape Town, South Africa. PLoS One 2023; 18:e0292534. [PMID: 38019851 PMCID: PMC10686431 DOI: 10.1371/journal.pone.0292534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Sexually transmitted infections are among the most commonly occurring infections globally, with countries in sub-Saharan Africa exhibiting disproportionately higher prevalence rates. Numerous reports indicate the need for accurate detection, epidemiological characterisation, and appropriate management of these infections. This prospective observational laboratory study sought to determine the occurrence of STI, using a validated molecular assay as a diagnostic and surveillance tool in our setting. METHODS Urogenital swabs from symptomatic and asymptomatic patients, submitted to the National Health Laboratory Service, at Groote Schuur Hospital, from 04 August 2021-03 February 2022, for routine microbiological investigations, were subjected to the Allplex™ STI Essential Assay (Seegene Inc, South Korea) to determine the distribution of STI pathogens in our setting. This multiplex assay includes C. trachomatis, Mycoplasma genitalium, Mycoplasma hominis, N. gonorrhoeae, Trichomonas vaginalis, Ureaplasma parvum, and Ureaplasma urealyticum. Correlations between detected organisms and participant age and clinical indications for testing were determined using Stata® software. RESULTS A total of 148 urogenital swabs (91.2% from women) were included in the analysis, of which 56/148 (37.84%) were from symptomatic patients. Up to 83.8% of the samples tested positive for ≥1 organism, with all seven target organisms detected in at least one sample. Ureaplasma parvum was the most common organism detected, followed by N. gonorrhoeae, M. hominis, U. urealyticum, T. vaginalis, C. trachomatis, with M. genitalium being the least detected. All 25 samples submitted for routine antenatal Group B Streptococcal screening were positive for at least one STI organism, and one sample from sexual non-accidental injury tested positive for five different organisms. CONCLUSIONS STIs comprise a variety of organisms in our setting, with many patients exhibiting coinfection with multiple organisms. This suggests the need for a critical evaluation of current syndromic testing and treatment guidelines so as to stem inadvertent spread of STI organisms and the development of resistance. The use of molecular testing methods may improve detection, especially in resource limited settings, providing speedy results, and thus allowing for guided therapy in only infected patients.
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Affiliation(s)
- Clinton Moodley
- Division of Medical Microbiology, Anzio Road Observatory, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Observatory, Cape Town, South Africa
| | - Hafsah Tootla
- Division of Medical Microbiology, Anzio Road Observatory, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Observatory, Cape Town, South Africa
| | - Imaan Amien
- Division of Medical Microbiology, Anzio Road Observatory, University of Cape Town, Cape Town, South Africa
| | - Mark E. Engel
- Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa
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Hutton-Nyameaye AA, Saah FI, Bedzina I, Somuah SO, Mensah KB, Duedu KO, Buabeng KO. Management of sexually transmitted infections: a qualitative assessment of community pharmacy practices in the Ho Municipality, Ghana. J Pharm Policy Pract 2023; 16:140. [PMID: 37950337 PMCID: PMC10636839 DOI: 10.1186/s40545-023-00650-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Effective management of sexually transmitted infections (STIs) is crucial in the control and spread of these infections in health systems. Community pharmacies are usually the first port of call in Ghana for most people who contract STIs for therapy. Delayed and inappropriate treatment contributes significantly to treatment failures, drug resistance and complications. However, the community pharmacies may not have diagnostic tools and trained personnel for prompt case detection and appropriate therapeutic action. Thus, posing a higher risk for inappropriate therapy with consequences of worsening symptoms and poor treatment outcomes. This study explored the STI management practices in community pharmacies in the Ho Municipality. METHODS Purposively selected study participants were community pharmacy staff including Pharmacists (n = 6), Pharmacy Technicians (n = 2) and Dispensing Assistants (n = 10) in outlets in Ho Municipality of the Volta region, Ghana. Data collection was carried out from December 2020 to January 2021. In-depth interviews of the participants using a semi-structured interview guide were conducted and recorded. Data obtained was transcribed and analyzed using NVivo version 12 using the thematic framework. RESULTS Some of the pharmacy staff were unaware of National Standard Treatment Guidelines (STG) and its recommendations for STI management. More than half of the participants believed the STG recommendations were important for therapy but few thought the STG recommendations were ineffective sometimes. Appropriate STI management practices observed included infection treatment based on laboratory data, and STG protocols that recommend syndromic approach. Negative STI management practices included disregarding the presence of possible mixed infections and treating all symptoms observed empirically as a single infection without laboratory confirmation. CONCLUSION The STI management practices in the community pharmacies had many gaps that risk infective therapy, treatment failures, STI complications, and antibiotic resistance. Efforts should be invested into the training of practitioners in community pharmacies for safe and effective practices for STI management, and encouraged to have diagnostic kits or work with laboratory facilities for testing to inform definitive therapy for optimal outcomes.
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Affiliation(s)
- Araba Ata Hutton-Nyameaye
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana.
| | - Farrukh Ishaque Saah
- Department of Epidemiology and Biostatistics, FN Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- Department of Population and Health, Faculty of Social Sciences, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Israel Bedzina
- Department of Medical Laboratory, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Samuel Owusu Somuah
- Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Kofi Boamah Mensah
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwabena Obeng Duedu
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
- College of Life Sciences, Birmingham City University, City South Campus, Birmingham, UK
| | - Kwame Ohene Buabeng
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Perez-Fernandez J, Arroyo-Velasco DO, Huaman MR, Chavez-Bustamante SG, Llamo-Vilcherrez AP, Delgado-Flores CJ, Toro-Huamanchumo CJ. Association between early sexual initiation and sexually transmitted infections among Peruvian reproductive-age women. Front Public Health 2023; 11:1191722. [PMID: 37790721 PMCID: PMC10544918 DOI: 10.3389/fpubh.2023.1191722] [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: 03/22/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
Background Sexually transmitted infections (STIs) are a serious public health problem worldwide, especially among reproductive-age women. The early sexual onset of sexual intercourse (EOSI) has been suggested as a risk factor, although there is no data at the national level. Objective To evaluate the association between EOSI and STIs in Peruvian women of childbearing age. Methods Analytical cross-sectional study with secondary data analyzes of the Peruvian Demographic and Family Health Survey 2018. The outcome was the presence of STIs in the last 12 months and the exposure variable was EOSI (age < 15 years at the time of their first sexual experience). To evaluate the association of interest, crude and adjusted prevalence ratios (aPRs) were calculated using generalized linear models with Poisson family and logarithmic link function. Results We analyzed data from 31,028 women of childbearing age. The 11.3% reported having STIs in the last 12 months and 20.2% of the participants had an EOSI. After adjusting for potential confounders, we found that EOSI was associated with STIs (aPR: 1.27; 95% CI: 1.08-1.50; p = 0.005). When conducting stratified analysis by area of residence and number of sexual partners, this association was maintained in women living in urban areas (aPR: 1.36; 95% CI: 1.11-1.66; p = 0.003) those who did not report having a history of multiple sexual partners (aPR: 1.27; 95% CI: 1.08-1.51; p = 0.005), and those in the middle (aPR: 1.42; 95% CI: 1.03-1.97; p = 0.034) and highest (aPR: 2.12; 95% CI: 1.33-3.39; p = 0.002) wealth quintiles. Conclusion Among reproductive-age women from Peru, EOSI was associated with STIs, especially in women living in urban areas, with no history of multiple sexual partners, and belonging to the middle to higher wealth index. The implementation of measures to prevent EOSI and fostering appropriate sexual health counseling for women with EOSI is advised.
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Affiliation(s)
| | | | - Mariella R. Huaman
- Sociedad Científica San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Anita P. Llamo-Vilcherrez
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Carolina J. Delgado-Flores
- Carrera de Farmacia y Bioquímica, Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru
| | - Carlos J. Toro-Huamanchumo
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- OBEMET Centro de Obesidad y Salud Metabólica, Lima, Peru
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9
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Mussa A, Wynn A, Ryan R, Babalola CM, Hansman E, Simon S, Bame B, Tamuthiba L, Ramontshonyana K, Ndlovu N, Moshashane N, Masole M, Klausner JD, Morroni C. Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infection and associated factors among asymptomatic pregnant women in Botswana. Int J STD AIDS 2023:9564624231163203. [PMID: 36930946 DOI: 10.1177/09564624231163203] [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: 03/19/2023]
Abstract
BACKGROUND Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonorrhoeae) are curable sexually transmitted infections (STIs) that cause adverse pregnancy and neonatal outcomes. Most countries, including Botswana, do not offer C. trachomatis or N. gonorrhoeae screening during antenatal care (ANC) and instead use a syndromic approach for management of STIs. METHODS The Maduo Study is a prospective, cluster-controlled trial in Botswana evaluating the impact of diagnostic screening for antenatal C. trachomatis and N. gonorrhoeae infections to prevent adverse neonatal outcomes. Using baseline data from the Maduo Study (March 2021-March 2022), we determined the prevalence of C. trachomatis and N. gonorrhoeae infection among asymptomatic pregnant women in Botswana and correlates of infection using multivariable logistic regression. RESULTS Of 251 women who underwent C. trachomatis and N. gonorrhoeae screening at first ANC visit, 55 (21.9%, 95%CI 17.0-27.5) tested positive for C. trachomatis, 1 (0.4%, 95%CI 0-2.2) for N. gonorrhoeae; and 2 (0.8%, 95%CI 0-2.8) for dual C. trachomatis and N. gonorrhoeae infection. Older age was associated with lower odds (aOR 0.93; 95%CI 0.88-0.98; p = 0.011) while any alcohol use during pregnancy was associated with higher odds (aOR = 3.53; 95%CI 1.22-10.16; p = 0.020) of testing positive for C. trachomatis or N. gonorrhoeae. CONCLUSIONS A high frequency of C. trachomatis infections was detected among asymptomatic pregnant women in Botswana indicating that many antenatal STIs are missed by the syndromic management approach. Our results highlight the need for diagnostic C. trachomatis screening during ANC in Botswana and other low- and middle-income countries that rely solely on the syndromic approach for management of STIs.
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Affiliation(s)
- Aamirah Mussa
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Adriane Wynn
- Division of Infectious Diseases and Global Public Health, 8784University of California San Diego, La Jolla, CA, USA
| | - Rebecca Ryan
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Emily Hansman
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,University of California, Los Angeles, CA, USA
| | - Selebaleng Simon
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Bame Bame
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Lefhela Tamuthiba
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Neo Ndlovu
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Neo Moshashane
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Maitumelo Masole
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Chelsea Morroni
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
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10
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Shewarega ES, Fentie EA, Asmamaw DB, Negash WD, Fetene SM, Teklu RE, Aragaw FM, Alemu TG, Eshetu HB, Belay DG. Sexually transmitted infections related care-seeking behavior and associated factors among reproductive age women in East Africa: a multilevel analysis of demographic and health surveys. BMC Public Health 2022; 22:1714. [PMID: 36085047 PMCID: PMC9463758 DOI: 10.1186/s12889-022-14120-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 09/01/2022] [Indexed: 12/04/2022] Open
Abstract
Background Sexually transmitted infections are serious global public health issue, and their consequences contribute significantly to population morbidity and mortality, especially in Sub-Saharan Africa. However, there is limited information about the sexually transmitted infections related care-seeking behavior in East Africa. Therefore, this study aimed to assess the pooled prevalence of sexually transmitted infections related care-seeking behavior, and associated factors among reproductive-age women in East Africa using the recent Demographic and Health Survey. Methods This study was based on recent Demographic and Health Survey of 8 East African countries from 2008/09 to 2018/2019. A total weighted sample of 12,004 reproductive-age women who reported sexually transmitted infections or symptoms of sexually transmitted infections in the last 12 months wereincluded. A multi-level mixed-effect logistic regression model was used and a P-value of < 0.05 was considered a statistically significant level for identification of individual and community level factors and AOR with a 95% l CI was computed. Result The overall prevalence of sexually transmitted infections related care-seeking behavior among reproductive-age women in East African countries was 54.14% [95% CI: 53.25%, 55.03%]. In multilevel analysis: being age 25–34 [AOR = 1.27 95%CI: 1.15–1.41], 35–49 [AOR = 1.26 95%CI: 1.13–1.41], women who attained secondary or above education [AOR = 1.27, 95% CI: 1.09, 1.47], being in rich household [AOR = 1.27, 95% CI 1.14, 1.41], women who were currently pregnant [AOR = 1.29, 95% CI 1.13, 1.47], who had been tested for HIV [AOR = 1.99, 95% CI 1.70, 2.33], women who had one and more than one sexual partner [AOR = 1.18, 95% CI 1.05, 1.34], women who lived in urban area [AOR = 1.16, 95% CI: 1.03, 1.31] and who perceived distance from the health facility was not a big problem was [AOR = 1.13, 95% CI 1.04, 1.23] were significantly associated with sexually transmitted infections related care-seeking behavior. Conclusion sexually transmitted infections related care-seeking behavior is relatively low as compared with other studies.. This study revealed that individual-level variables such as women's age, educational status, household wealth index, pregnancy status, ever been tested for HIV, number of sexual partners, and community-level variables such as residence and distance from a health facility were associated with sexually transmitted infections related care-seeking behavior. Therefore, public health interventions targeting uneducated women, poor households, and adolescents, as well as improving counseling and awareness creation during HIV/AIDS testing and Antenatal care visits, are vital to improving sexually transmitted infections care seeking behavior.
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11
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Noiman A, Esber A, Wang X, Bahemana E, Adamu Y, Iroezindu M, Kiweewa F, Maswai J, Owuoth J, Maganga L, Ganesan A, Maves RC, Lalani T, Colombo RE, Okulicz JF, Polyak C, Crowell TA, Ake JA, Agan BK. Clinical factors and outcomes associated with immune non-response among virally suppressed adults with HIV from Africa and the United States. Sci Rep 2022; 12:1196. [PMID: 35075147 PMCID: PMC8786968 DOI: 10.1038/s41598-022-04866-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 12/24/2021] [Indexed: 11/21/2022] Open
Abstract
A significant minority of people living with HIV (PLWH) achieve viral suppression (VS) on antiretroviral therapy (ART) but do not regain healthy CD4 counts. Clinical factors affecting this immune non-response (INR) and its effect on incident serious non-AIDS events (SNAEs) have been challenging to understand due to confounders that are difficult to control in many study settings. The U.S. Military HIV Natural History Study (NHS) and African Cohort Study (AFRICOS). PLWH with sustained VS (< 400 copies/ml for at least two years) were evaluated for INR (CD4 < 350 cells/µl at the time of sustained VS). Logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with INR. Cox proportional hazards regression produced adjusted hazard ratios (aHRs) for factors associated with incident SNAE after sustained VS. INR prevalence was 10.8% and 25.8% in NHS and AFRICOS, respectively. Higher CD4 nadir was associated with decreased odds of INR (aOR = 0.34 [95% CI 0.29, 0.40] and aOR = 0.48 [95% CI 0.40, 0.57] per 100 cells/µl in NHS and AFRICOS, respectively). After adjustment, INR was associated with a 61% increase in relative risk of SNAE [95% CI 1.12, 2.33]. Probability of "SNAE-free" survival at 15 years since sustained VS was approximately 20% lower comparing those with and without INR; nearly equal to the differences observed by 15-year age groups. CD4 monitoring before and after VS is achieved can help identify PLWH at risk for INR. INR may be a useful clinical indicator of future risk for SNAEs.
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Affiliation(s)
- Adi Noiman
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. .,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA. .,Infectious Disease Clinical Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 600, Rockville, MD, 20852, USA.
| | - Allahna Esber
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Xun Wang
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Emmanuel Bahemana
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation MRI, Mbeya, Tanzania
| | - Yakubu Adamu
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,U.S. Army Medical Research Directorate-Africa, Nairobi, Kenya.,Henry M. Jackson Foundation MRI, Abuja, Nigeria
| | - Michael Iroezindu
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,U.S. Army Medical Research Directorate-Africa, Nairobi, Kenya.,Henry M. Jackson Foundation MRI, Abuja, Nigeria
| | | | - Jonah Maswai
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Kenya Medical Research Institute, Nairobi, Kenya.,Henry M. Jackson Foundation MRI, Kericho, Kenya
| | - John Owuoth
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Kenya Medical Research Institute, Nairobi, Kenya.,Henry M. Jackson Foundation MRI, Kisumu, Kenya
| | - Lucas Maganga
- National Institute of Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CA, USA
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,Madigan Army Medical Center, Joint Base Lewis-McChord, WA, USA
| | - Jason F Okulicz
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Brooke Army Medical Center, San Antonio, TX, USA
| | - Christina Polyak
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Trevor A Crowell
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Division of Infectious Diseases, Department of Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Julie A Ake
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Division of Infectious Diseases, Department of Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. .,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
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12
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Kranzer K, Simms V, Dauya E, Olaru ID, Dziva Chikwari C, Martin K, Redzo N, Bandason T, Tembo M, Francis SC, Weiss HA, Hayes RJ, Mavodza C, Apollo T, Ncube G, Machiha A, Ferrand RA. Identifying youth at high risk for sexually transmitted infections in community-based settings using a risk prediction tool: a validation study. BMC Infect Dis 2021; 21:1234. [PMID: 34879820 PMCID: PMC8653586 DOI: 10.1186/s12879-021-06937-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND : Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most common bacterial sexually transmitted infections (STIs) worldwide. In the absence of affordable point-of-care STI tests, WHO recommends STI testing based on risk factors. This study aimed to develop a prediction tool with a sensitivity of > 90% and efficiency (defined as the percentage of individuals that are eligible for diagnostic testing) of < 60%. METHODS This study offered CT/NG testing as part of a cluster-randomised trial of community-based delivery of sexual and reproductive health services to youth aged 16-24 years in Zimbabwe. All individuals accepting STI testing completed an STI risk factor questionnaire. The outcome was positivity for either CT or NG. Backwards-stepwise logistic regression was performed with p ≥ 0.05 as criteria for exclusion. Coefficients of variables included in the final multivariable model were multiplied by 10 to generate weights for a STI risk prediction tool. A maximum likelihood Receiver Operating Characteristics (ROC) model was fitted, with the continuous variable score divided into 15 categories of equal size. Sensitivity, efficiency and number needed to screen were calculated for different cut-points. RESULTS From 3 December 2019 to 5 February 2020, 1007 individuals opted for STI testing, of whom 1003 (99.6%) completed the questionnaire. CT/NG prevalence was 17.5% (95% CI 15.1, 19.8) (n = 175). CT/NG positivity was independently associated with being female, number of lifetime sexual partners, relationship status, HIV status, self-assessed STI risk and past or current pregnancy. The STI risk prediction score including those variables ranged from 2 to 46 with an area under the ROC curve of 0.72 (95% CI 0.68, 0.76). Two cut-points were chosen: (i) 23 for optimised sensitivity (75.9%) and specificity (59.3%) and (ii) 19 to maximise sensitivity (82.4%) while keeping efficiency at < 60% (59.4%). CONCLUSIONS The high prevalence of STIs among youth, even in those with no or one reported risk factor, may preclude the use of risk prediction tools for selective STI testing. At a cut-point of 19 one in six young people with STIs would be missed.
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Affiliation(s)
- Katharina Kranzer
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. .,Biomedical Research and Training Institute, Harare, Zimbabwe. .,Division of Infectious and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany.
| | - Victoria Simms
- Biomedical Research and Training Institute, Harare, Zimbabwe.,MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ioana D Olaru
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Kevin Martin
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Nicol Redzo
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Mandikudza Tembo
- Biomedical Research and Training Institute, Harare, Zimbabwe.,MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanna C Francis
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen A Weiss
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard J Hayes
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Constancia Mavodza
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tsitsi Apollo
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Gertrude Ncube
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Anna Machiha
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Rashida Abbas Ferrand
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
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