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Wong NS, Chan DPC, Chung SL, Kwan TH, Lee KCK, Kwan CK, Lee SS. Self-sampled multi-anatomic site testing for uncovering the community burden of undiagnosed Chlamydia trachomatis and Neisseria gonorrhoeae infection in men who have sex with men. Infection 2024; 52:491-502. [PMID: 37857977 DOI: 10.1007/s15010-023-02107-7] [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: 08/09/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE To detect otherwise undiagnosed asymptomatic sexually transmitted infection (STI), and for estimating prevalence among men who have sex with men (MSM). METHODS In this community-based study in Hong Kong, adult MSM were recruited. After completion of an online survey, free multi-anatomic sites self-sampling kits (urine specimens, pharyngeal and rectal swabs) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) tests were delivered to requesting participants. Factors associated with STI positivity were analyzed in logistic regression. RESULTS From September 2021 to October 2022, 712 MSM were recruited, with 86% aged 18-39, and 16% reported history of chemsex engagement. A majority (81%) had previously undergone HIV testing, 68% had ever tested for STI, and 35% previously diagnosed with STI. Totally 428 (60%) had requested self-sampling kits, and 276 (39%) returned collected samples. Among participants who returned the samples, about half had never been tested in the past and had no history of STI. Overall 21% tested positive for CT and/or NG (CT/NG)-CT positive 16% and NG positive 7%. By anatomic site, 16% of rectal swabs, 7% of pharyngeal swabs, but just 3% of urine specimens were CT/NG positive. The prevalence of CT/NG was not significantly different by history of STI diagnosis and testing. CONCLUSION Self-sampled STI testing is a potentially useful means for enhancing uptake of screening in MSM in the community, which could uncover otherwise undiagnosed asymptomatic infections. Internet-based self-sampling for STI testing could complement the current clinic-based STI testing for supporting epidemiologic evaluation of STI control in the community.
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Affiliation(s)
- Ngai Sze Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, 2/F, Postgraduate Education Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
- S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Denise Pui-Chung Chan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, 2/F, Postgraduate Education Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
- S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Sze Long Chung
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, 2/F, Postgraduate Education Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
- S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Tsz Ho Kwan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, 2/F, Postgraduate Education Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
- S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Chi Keung Kwan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, 2/F, Postgraduate Education Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
- S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, 2/F, Postgraduate Education Centre, Prince of Wales Hospital, Shatin, Hong Kong, China.
- S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
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Vialard F, Anand A, Leung Soo C, de Waal A, McGuire M, Carmona S, Fernández-Suárez M, Zwerling AA, Pant Pai N. Self-sampling strategies (with/without digital innovations) in populations at risk of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analyses. Sex Transm Infect 2023; 99:420-428. [PMID: 36990696 PMCID: PMC10447399 DOI: 10.1136/sextrans-2022-055557] [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: 08/10/2022] [Accepted: 02/24/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) resulted in over 200 million new sexually transmitted infections last year. Self-sampling strategies alone or combined with digital innovations (ie, online, mobile or computing technologies supporting self-sampling) could improve screening methods. Evidence on all outcomes has not yet been synthesised, so we conducted a systematic review and meta-analysis to address this limitation. METHODS We searched three databases (period: 1 January 2000-6 January 2023) for reports on self-sampling for CT/GC testing. Outcomes considered for inclusion were: accuracy, feasibility, patient-centred and impact (ie, changes in linkage to care, first-time testers, uptake, turnaround time or referrals attributable to self-sampling).We used bivariate regression models to meta-analyse accuracy measures from self-sampled CT/GC tests and obtain pooled sensitivity/specificity estimates. We assessed quality with Cochrane Risk of Bias Tool-2, Newcastle-Ottawa Scale and Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS We summarised results from 45 studies reporting self-sampling alone (73.3%; 33 of 45) or combined with digital innovations (26.7%; 12 of 45) conducted in 10 high-income (HICs; n=34) and 8 low/middle-income countries (LMICs; n=11). 95.6% (43 of 45) were observational, while 4.4% (2 of 45) were randomised clinical trials.We noted that pooled sensitivity (n=13) for CT/GC was higher in extragenital self-sampling (>91.6% (86.0%-95.1%)) than in vaginal self-sampling (79.6% (62.1%-90.3%)), while pooled specificity remained high (>99.0% (98.2%-99.5%)).Participants found self-sampling highly acceptable (80.0%-100.0%; n=24), but preference varied (23.1%-83.0%; n=16).Self-sampling reached 51.0%-70.0% (n=3) of first-time testers and resulted in 89.0%-100.0% (n=3) linkages to care. Digital innovations led to 65.0%-92% engagement and 43.8%-57.1% kit return rates (n=3).Quality of studies varied. DISCUSSION Self-sampling had mixed sensitivity, reached first-time testers and was accepted with high linkages to care. We recommend self-sampling for CT/GC in HICs but additional evaluations in LMICs. Digital innovations impacted engagement and may reduce disease burden in hard-to-reach populations. PROSPERO REGISTRATION NUMBER CRD42021262950.
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Affiliation(s)
- Fiorella Vialard
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Apoorva Anand
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Cindy Leung Soo
- Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Anna de Waal
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Madison McGuire
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sergio Carmona
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | | | - Alice Anne Zwerling
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Nitika Pant Pai
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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