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Gios L, Mirandola M, Cordioli M, Zorzi A, Sherriff N, Vera J, Wlazly D, Hassan-Ibrahim MO, Padovese V, Anabel Darmanin, Peeling RW, Unemo M, Blondeel K, Toskin I. A multi-country comparative study of two treponemal tests for the serodiagnosis of syphilis amongst men who have sex with men (MSM): Chemo-luminescent assay vs Treponema pallidum particle agglutination assay. BMC Infect Dis 2024; 24:313. [PMID: 38486194 PMCID: PMC10941351 DOI: 10.1186/s12879-024-09100-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 02/02/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION International guidelines recommend routine screening for syphilis (aetiological agent: Treponema pallidum subspecies pallidum) amongst key populations and vulnerable populations using tests detecting treponemal and non-treponemal antibodies. Whilst treponemal tests have high sensitivities and specificities, they differ regarding subjective or objective interpretation, throughput and workload. Chemiluminescence immunoassays (CLIAs) are cost- and time-effective automated methods for detecting treponemal antibodies. The Treponema pallidum particle agglutination assay (TPPA) has been considered the "gold standard" treponemal assay, however, this includes a highly manual procedure, low throughput and subjective interpretation. The present multi-country study evaluated the ADVIA Centaur® Syphilis CLIA (Siemens Healthcare) assay compared to the reference SERODIA-TP·PA® (Fujirebio Diagnostics) for the serodiagnosis of syphilis amongst men who have sex with men (MSM). METHOD 1,485 MSM were enrolled in Brighton (UK), Malta, and Verona (Italy) as part of a larger WHO multi-country and multi-site ProSPeRo study. Ethical approval was obtained. Serum was tested with the ADVIA Centaur® Syphilis CLIA assay and SERODIA-TP·PA®, in accordance with the manufacturers' instructions, for a first round of validation. A second round of validation was carried out for discrepant results that were additionally tested with both Western Blot (Westernblot EUROIMMUN®) and an Immunoblot (INNO-LIA, Fujirebio Diagnostics). Sensitivity, specificity, positive and negative predictive value (PPV and NPV), likelihood ratios (positive/negative), and the Diagnostic Odds Ratio (DOR)/pre-post-test probability (Fagan's nomogram) were calculated. RESULTS Out of 1,485 eligible samples analysed in the first phase, the SERODIA-TP·PA® identified 360 positive and 1,125 negative cases. The ADVIA Centaur® Syphilis CLIA assay (Siemens) identified 366 positives, missclassifying one TPPA-positive sample. In the second phase, the ADVIA Centaur® Syphilis CLIA resulted in 1 false negative and 4 false positive results. Considering the syphilis study prevalence of 24% (95% CI: 22-26.7), The sensitivity of the ADVIA Centaur® Syphilis CLIA assay was 99.7% (95% CI: 98.5-100), and the specificity was 99.4% (95% CI: 98.7-99.7). The ROC area values were 0.996 (95% CI: 0.992-0.999), and both the PPV and NPV values were above 98% (PPV 98.1%, 95% CI: 96.1-99.2; NPV 99.9%, 95% CI: 99.5-100). CONCLUSIONS The ADVIA Centaur® Syphilis CLIA assay showed similar performance compared to the SERODIA-TP·PA®. Considering the study is based on QUADAS principles and with a homogeneous population, results are also likely to be generalisable to MSM population but potentially not applicable to lower prevalence populations routinely screened for syphilis. The automated CLIA treponemal assay confirmed to be accurate and appropriate for routine initial syphilis screening, i.e. when the reverse testing algorithm is applied.
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Affiliation(s)
- Lorenzo Gios
- Infectious Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy.
- WHO Collaborating Centre for Sexual Health and Vulnerable Populations - Epidemiology Unit - Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy.
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Piazzale L. Scuro, 10, 37134, Verona, Italy.
| | - Massimo Mirandola
- Infectious Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy
- WHO Collaborating Centre for Sexual Health and Vulnerable Populations - Epidemiology Unit - Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Maddalena Cordioli
- Infectious Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy
- WHO Collaborating Centre for Sexual Health and Vulnerable Populations - Epidemiology Unit - Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Antonella Zorzi
- WHO Collaborating Centre for Sexual Health and Vulnerable Populations - Epidemiology Unit - Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy
- Virology and Microbiology Unit, Department of Pathology and Diagnostics, Verona University Hospital, Verona, Italy
| | - Nigel Sherriff
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Jaime Vera
- Brighton & Sussex Medical School, University of Sussex and University of Brighton, Brighton, UK
| | - Dominika Wlazly
- Brighton & Sussex Medical School, University of Sussex and University of Brighton, Brighton, UK
| | - Mohammed Osman Hassan-Ibrahim
- Department of Microbiology & Infection, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust (Brighton & Haywards Heath Sites), Brighton, UK
| | - Valeska Padovese
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta, L-Imsida, Malta
| | - Anabel Darmanin
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta, L-Imsida, Malta
| | - Rosanna W Peeling
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Medical Microbiology Department, University of Manitoba, Winnipeg, MB, Canada
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London (UCL), London, UK
| | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), World Health Organization, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), World Health Organization, Geneva, Switzerland
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Shephard M, Matthews S, Kularatne R, Andrewartha K, Blondeel K, Alvarez C, Camey E, Hançali A, Müller E, Haw A, Oumzil H, Golparian D, Ramirez DE, Kiarie J, Kurbonov F, Mirandola M, Peeling RW, Silva R, Thwin SS, Unemo M, Toskin I. Independent clinic-based evaluation of point-of-care testing for the screening of Chlamydia trachomatis, Neisseria gonorrhoea and Trichomonas vaginalis in women-at-risk in Australia, Guatemala, Morocco, and South Africa. BMC Infect Dis 2024; 24:277. [PMID: 38438953 PMCID: PMC10910521 DOI: 10.1186/s12879-024-09018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/11/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND In 2018, the World Health Organization commenced a multi-country validation study of the Cepheid GeneXpert for a range of molecular-based point-of-care (POC) tests in primary care settings. One study arm focused on the evaluation of POC tests for screening 'women at risk' for chlamydia (CT), gonorrhoea (NG) and trichomonas (TV) in four countries - Australia, Guatemala, Morocco and South Africa. METHODS Study participants completed a pre-test questionnaire which included demographics, clinical information and general questions on POC testing (POCT). Two vaginal swab samples (either self-collected or clinician collected) from each patient were tested on the GeneXpert at the POC and at a reference laboratory using quality-assured nucleic acid amplification tests (NAATs). RESULTS One thousand three hundred and eighty-three women were enrolled: 58.6% from South Africa, 29.2% from Morocco, 6.2% from Guatemala, and 6.0% from Australia. 1296 samples for CT/NG and 1380 samples for TV were tested by the GeneXpert and the reference NAAT. The rate of unsuccessful tests on the GeneXpert was 1.9% for CT, 1.5% for NG and 0.96% for TV. The prevalence of CT, NG and TV was 31%, 13% and 23%, respectively. 1.5% of samples were positive for all three infections; 7.8% were positive for CT and NG; 2.4% were positive for NG and TV; and 7.3% were positive for CT and TV. Compared to reference NAATs, pooled estimates of sensitivity for the GeneXpert tests were 83.7% (95% confidence intervals 69.2-92.1) for CT, 90.5% (85.1-94.1) for NG and 64.7% (58.1-70.7) for TV (although estimates varied considerably between countries). Estimates for specificity were ≥96% for all three tests both within- and between-countries. Pooled positive and negative likelihood ratios were: 32.7 ([CI] 21.2-50.5) and 0.17 (0.08-0.33) for CT; 95.3 (36.9-245.7) and 0.10 (0.06-0.15) for NG; and 56.5 (31.6-101.1) and 0.35 (0.27-0.47) for TV. CONCLUSION This multi-country evaluation is the first of its kind world-wide. Positive likelihood ratios, as well as specificity estimates, indicate the GeneXpert POC test results for CT, NG and TV were clinically acceptable for ruling in the presence of disease. However, negative likelihood ratios and variable sensitivity estimates from this study were poorer than expected for ruling out these infections, particularly for TV. TRIAL REGISTRATION Ethics approval to conduct the ProSPeRo study was granted by the WHO Ethics Review Committee, as well as local ethics committees from all participating countries.
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Affiliation(s)
- Mark Shephard
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, South Australia, Australia.
| | - Susan Matthews
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, South Australia, Australia
| | - Ranmini Kularatne
- Centre for HIV & STI, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Kelly Andrewartha
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, South Australia, Australia
| | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Elsy Camey
- Sida y Sociedad, ONG (SISO), Escuintla, Guatemala
| | | | - Etienne Müller
- Centre for HIV & STI, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Aurelie Haw
- Médecins sans Frontières, Khayelitsha, Cape Town, South Africa
| | | | - Daniel Golparian
- WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Dorian E Ramirez
- Facultad de Ciencias Médicas, Universidad de San Carlos de Guatemala, Guatemala City, Guatemala
| | - James Kiarie
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Firdavs Kurbonov
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- School of Sport and Health Sciences, University of Brighton, Brighton, United Kingdom
| | - Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ronaldo Silva
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Soe Soe Thwin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London, London, United Kingdom
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Cordioli M, Gios L, Erbogasto A, Mirandola M, Sandri A, Padovese V, Caceres C, Vargas S, Blondeel K, Silva R, Kiarie J, Kurbonov F, Peeling RW, Thwin SS, Golparian D, Unemo M, Toskin I. Clinic-based evaluation of the dual Xpert CT/NG assay on the GeneXpert System for screening for extragenital chlamydial and gonococcal infections amongst men who have sex with men. BMC Infect Dis 2024; 24:224. [PMID: 38418963 PMCID: PMC10902931 DOI: 10.1186/s12879-024-09042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections have increased globally. Asymptomatic infections represent a significant risk of long-term complications. Men who have sex with men (MSM) are disproportionally affected, underscoring the need to offer screening programmes to this population. CT/NG Point of Care Testing (POCT) constitutes a strategic tool to improve the continuum of STI care, however extensive real-life evaluations amongst at risk populations are lacking. The aim of this study is to estimate the GeneXpert CT/NG assay performance and usability for CT and NG at genital and extragenital sites for screening amongst MSM. METHODS This study was a multi-site sexual health clinic-based evaluation (Italy, Malta and Peru) with consecutive enrolment. A first void urine sample (divided in two aliquots), two oropharyngeal and two anorectal swabs were collected for each study participant. One specimen set (one for each anatomical site) was tested with the dual index test (Cepheid) at the clinics by the healthcare staff, the other set with FDA/CE approved Nucleic Acid Amplification Tests (NAATs) at the laboratory. Clinical sites and reference laboratories participated in an internal and external quality control programme. Sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values for each anatomical site were estimated using a meta-analytic approach. RESULTS One thousand seven hundred two MSM were recruited across all clinical sites for a total of 5049 biological specimens. NG and CT were respectively detected in 274 and 287 of samples. Overall, the NG POCT sensitivity and specificity was 91.43% and 99.75% in urine (LR + 372.80, LR- 0.09), 89.68% and 99.55% in rectal specimens (LR + 197.30, LR- 0.10) and 75.87% and 98.77% at the pharynx respectively (LR + 61.94, LR- 0.24). The CT component of the POCT sensitivity was 84.82% and specificity 99.63% in urine (LR + 228.68, LR- 0.15), 78.07% and 99.19% respectively on rectal site (LR + 96.23, LR-0.22), 67.79% and 99.88% respectively at pharyngeal site (LR + 554.89, LR- 0.32). 95.95% of MSM reported to be willing to wait for POCT results and no provider reported difficulties in terms of performance or interpretation of the results of the Xpert CT/NG. CONCLUSION Rapid turnaround time, ease of use and high acceptability make the Xpert CT/NG testing system a strategic tool for increasing testing frequency, reaching those not yet tested and offering the possibility of immediate treatment if needed. The assay showed good negative likelihood ratios and confirms its use to rule out CT/NG infections. Sensitivity varied across sites and pathogens. Periodic staff training at the testing sites should be mandatory.
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Affiliation(s)
- Maddalena Cordioli
- Infectious Diseases Section, Department of Medicine, Verona University Hospital, Verona, Italy.
- WHO Collaborating Centre for Sexual Health and Vulnerable Populations - Epidemiology Unit - Division of Infectious Diseases, Verona University Hospital, Verona, Italy.
| | - Lorenzo Gios
- Infectious Diseases Section, Department of Medicine, Verona University Hospital, Verona, Italy
- WHO Collaborating Centre for Sexual Health and Vulnerable Populations - Epidemiology Unit - Division of Infectious Diseases, Verona University Hospital, Verona, Italy
| | - Anna Erbogasto
- Infectious Diseases Section, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Medicine, Verona University Hospital, Verona, Italy
- WHO Collaborating Centre for Sexual Health and Vulnerable Populations - Epidemiology Unit - Division of Infectious Diseases, Verona University Hospital, Verona, Italy
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Angela Sandri
- Microbiology Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Valeska Padovese
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
| | - Carlos Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver Vargas
- Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), World Health Organization, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ronaldo Silva
- Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), World Health Organization, Geneva, Switzerland
| | - James Kiarie
- Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), World Health Organization, Geneva, Switzerland
| | - Firdavs Kurbonov
- Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), World Health Organization, Geneva, Switzerland
| | - Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Soe Soe Thwin
- Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), World Health Organization, Geneva, Switzerland
| | - Daniel Golparian
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London (UCL), London, UK
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), World Health Organization, Geneva, Switzerland
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Sherriff N, Mirandola M, Silva R, Cordioli M, Sawyer A, Gios L, Zorzi A, Huber J, Vera J, Richardson D, Hassan-Ibrahim M, Wlazly D, Padovese V, Barbara C, Darmanin A, Schembri A, Caceres C, Vargas S, Blondeel K, Kiarie J, Kurbonov F, Peeling RW, Thwin SS, Toskin I. Independent clinic-based evaluation of dual POCTs for screening for HIV and syphilis in men who have sex with men in Italy, Malta, Peru, and the United Kingdom. BMC Infect Dis 2024; 24:192. [PMID: 38418941 PMCID: PMC10902927 DOI: 10.1186/s12879-024-09019-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/11/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Globally, the incidence of HIV and syphilis can be reduced by the use of validated point of care tests (POCTs). As part of the WHO PRoSPeRo Network, we aimed to evaluate the performance, acceptability, and operational characteristics of two dual HIV/syphilis POCTs (Bioline HIV/Syphilis Duo (Abbott) and DPP® HIV-Syphilis assay (Chembio) for the screening of HIV and syphilis amongst men who have sex with men (MSM). METHOD AND ANALYSES A cross sectional study of 2,577 MSM in Italy, Malta, Peru, and the United Kingdom (UK) presenting to seven clinic sites, were enrolled. Finger prick blood was collected to perform POCTs and results compared with standard laboratory investigations on venepuncture blood. Acceptability and operational characteristics were assessed using questionnaires. Diagnostic meta-analysis was used to combine data from the evaluation sites. RESULTS Based on laboratory tests, 23.46% (n = 598/2549) of participants were confirmed HIV positive, and 35.88% of participants (n = 901/2511) were positive on treponemal reference testing. Of all participants showing evidence of antibodies to Treponema pallidum, 50.56% (n = 455/900) were Rapid Plasma Reagin (RPR) test reactive. Of HIV positive individuals, 60.62% (n = 354/584) had evidence of antibodies to T. pallidum, and of these 60.45% (n = 214/354) exhibited reactive RPR tests indicating probable (co)infection. For Bioline POCT, pooled sensitivities and specificities for HIV were 98.95% and 99.89% respectively, and for syphilis were 73.79% and 99.57%. For Chembio pooled sensitivities and specificities for HIV were 98.66% and 99.55%, and for syphilis were 78.60% and 99.48%. Both tests can detect greater than 90% of probable active syphilis cases, as defined by reactive RPR and treponemal test results. These dual POCTs were preferred by 74.77% (n = 1,926) of participants, due to their convenience, and the operational characteristics made them acceptable to health care providers (HCPs). CONCLUSIONS Both the Bioline and the Chembio dual POCT for syphilis and HIV had acceptable performance, acceptability and operational characteristics amongst MSM in the PRoSPeRo network. These dual POCTs could serve as a strategic, more cost effective, patient and healthcare provider (HCP) friendly alternative to conventional testing; in clinical and other field settings, especially those in resource-limited settings.
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Affiliation(s)
- Nigel Sherriff
- School of Sport and Health Sciences, University of Brighton, Village Way, Falmer, BN1 9PH, UK.
- Centre for Transforming Sexuality and Gender, University of Brighton, Edward Street, Brighton, BN2 0JG, UK.
| | - Massimo Mirandola
- School of Sport and Health Sciences, University of Brighton, Village Way, Falmer, BN1 9PH, UK
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Ronaldo Silva
- World Health Organization, Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), Geneva, Switzerland
| | - Maddalena Cordioli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alexandra Sawyer
- School of Sport and Health Sciences, University of Brighton, Village Way, Falmer, BN1 9PH, UK
| | - Lorenzo Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Antonella Zorzi
- Microbiology and Virology Unit, Molecular Biology Department, Padua University Hospital, Padua, Italy
| | - Jorg Huber
- School of Sport and Health Sciences, University of Brighton, Village Way, Falmer, BN1 9PH, UK
| | - Jaime Vera
- Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Daniel Richardson
- Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Mohammed Hassan-Ibrahim
- Department of Microbiology & Infection, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Dominika Wlazly
- Royal Sussex County Hospital Brighton, CIRU Research Laboratory, Brighton, UK
| | - Valeska Padovese
- Department of Dermatology and Venereology, Genito-Urinary Clinic, Mater Dei Hospital, Msida, Malta
| | | | | | - Aaron Schembri
- Infectious Diseases Unit, Mater Dei Hospital, Msida, Malta
| | - Carlos Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver Vargas
- Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Karel Blondeel
- World Health Organization, Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - James Kiarie
- World Health Organization, Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), Geneva, Switzerland
| | - Firdavs Kurbonov
- World Health Organization, Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), Geneva, Switzerland
| | - Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Soe Soe Thwin
- World Health Organization, Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), Geneva, Switzerland
| | - Igor Toskin
- World Health Organization, Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), Geneva, Switzerland
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Fernàndez-López L, Reyes-Urueña J, Egea L, Chernyshev A, Upmace I, Ćosić M, Mejías W, González V, Blondeel K, Thwin SS, Gios L, Mirandola M, Peeling R, Kiarie J, Casabona J, Toskin I. A clinical utility evaluation of dual HIV/Syphilis point-of-care tests in non-clinical settings for screening for HIV and syphilis in men who have sex with men. BMC Infect Dis 2024; 24:264. [PMID: 38419023 PMCID: PMC10902924 DOI: 10.1186/s12879-024-09017-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/11/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Dual point-of-care tests (POCTs) for the simultaneous detection of antibodies to HIV and syphilis have been developed. Since community-based organisations (CBO) are effective providers of HIV and syphilis testing among men who have sex with men (MSM), evaluation of the utility of these dual tests at CBO testing services is a high priority. The aim of this study is to determine the feasibility of performing dual HIV-syphilis POCT testing among both users and providers at these non-clinical sites. METHODS This evaluation assessed the utility of two lateral flow immunochromatographic antibody technologies for dual screening for HIV/syphilis among MSM seeking testing in four CBO testing services in Spain, Slovenia, Latvia, and Ukraine. The study's conceptual framework divides the concept of feasibility into two inter-related domains, acceptability, and usability and further breaks it down into six subdomains: learnability, willingness, suitability, satisfaction, efficacy, and effectiveness. The feasibility analysis was performed by calculating the median score in 3 stages (for individual questions, subdomains, and domains), using a summated scores method. RESULTS The final sample included 844 participants, 60 of which were found to be HIV test positive (7.1%) and 61 (7.2%) positive on testing for syphilis. There was a small difference (1.1%) when comparing the results of the two dual POCTs under evaluation to the tests routinely used at each site. The inter-rater agreement showed a high concordance between two independent readings. The analysis of the feasibility for the users of the services indicated good satisfaction, suitability, and willingness. In addition, among 18 providers the total mean score showed good acceptability and usability, good willingness, easy learnability, high suitability, and good efficacy, but lower satisfaction and effectiveness. The operational characteristics of both dual study POCTs were well evaluated by providers. CONCLUSIONS The introduction of dual HIV and syphilis POCTs in CBO testing services for screening of MSM is feasible, with a high acceptability and usability both for users and providers. Implementation of dual POCTs for HIV and syphilis in CBO testing services is an opportunity for scaling up integrated HIV/syphilis testing for MSM.
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Affiliation(s)
- Laura Fernàndez-López
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain.
- Institute for Health Science Research Germans Trias I Pujol (IGTP), Badalona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Juliana Reyes-Urueña
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Institute for Health Science Research Germans Trias I Pujol (IGTP), Badalona, Spain
| | - Laia Egea
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- School of Mathematics, Statistics and Operations Research, Victoria University of Wellington, Wellington, New Zealand
| | | | | | | | | | - Victoria González
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Institute for Health Science Research Germans Trias I Pujol (IGTP), Badalona, Spain
- Microbiology Department, Laboratori Clínic Metropolitana Nord. Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research (SRH), including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Soe Soe Thwin
- Department of Sexual and Reproductive Health and Research (SRH), including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Lorenzo Gios
- Epidemiology Unit - Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Massimo Mirandola
- Epidemiology Unit - Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Rosanna Peeling
- International Diagnostics Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - James Kiarie
- Department of Sexual and Reproductive Health and Research (SRH), including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Jordi Casabona
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Institute for Health Science Research Germans Trias I Pujol (IGTP), Badalona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research (SRH), including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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6
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Shephard M, Matthews S, Andrewartha K, Dimech W, Cabuang L, Barbara C, Chen XS, Cordioli M, Hançali A, Jiang TT, Kularatne R, Meli S, Muller E, Oumzil H, Padovese V, Sandri A, Vargas S, Zahra G, Unemo M, Blondeel K, Toskin I. Quality control and external quality assessment for the independent clinic-based evaluation of point-of-care testing to detect Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis in eight countries. BMC Infect Dis 2024; 24:203. [PMID: 38418947 PMCID: PMC10902926 DOI: 10.1186/s12879-024-09057-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Sexually transmitted infections caused by Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) remain significant global health problems. The World Health Organization (WHO) has recently conducted a multi-faceted, multi-country validation study (ProSPeRo), which included an evaluation of the Xpert CT/NG and Xpert TV assays on the GeneXpert system (Cepheid, Sunnyvale, Ca., USA) in clinic-based settings across eight countries. To support the study, a training and quality management system was implemented and evaluated. METHODS A comprehensive training program for the study was developed. Quality control (QC) and external quality assessment (EQA) samples were provided by an accredited quality assurance provider. QC testing was conducted at 14 point-of-care testing (POCT) clinics, while EQA samples were tested by the POCT sites and a reference laboratory supporting each clinic. RESULTS For QC testing, concordance with the expected results for CT and NG was > 99% and rates of unsuccessful tests were < 4%. For TV testing, concordance was similar (97%), but rates of unsuccessful tests were high (18%), particularly in the 'TV negative' sample. For EQA testing initially conducted in 2018, concordance was 100% for CT and NG, and 90% for TV for the reference laboratory group (which used non-GeneXpert systems). Concordance for the POCT group was also high (> 94%) for all analytes, but this cohort (which used GeneXpert systems) exhibited a high rate of unsuccessful TV tests. All but one of these unsuccessful tests was subcategorised as 'invalid'. CONCLUSIONS The high level of concordance for QC and EQA testing confirm that the trained operators at the POC clinical sites were competent to conduct POC testing and that the training and quality systems implemented for the ProSPeRo study were effective. The quality materials used were satisfactory for CT and NG but exhibited poor performance for TV testing on the GeneXpert system. The WHO should continue to work with industry and EQA providers to provide improved materials that are reliable, stable and cost effective for quality management, as it seeks to rollout molecular-based STI POCT in non-laboratory-based settings. TRIAL REGISTRATION Ethics approval to conduct the ProSPeRo study was granted by the WHO Ethics Review Committee.
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Affiliation(s)
- Mark Shephard
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, South Australia, Australia.
| | - Susan Matthews
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, South Australia, Australia
| | - Kelly Andrewartha
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, South Australia, Australia
| | - Wayne Dimech
- National Serology Reference Laboratory, Australia, Fitzroy, Victoria, Australia
| | - Liza Cabuang
- National Serology Reference Laboratory, Australia, Fitzroy, Victoria, Australia
| | | | - Xiang-Sheng Chen
- Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, National Center for STD Control, Nanjing, China
| | - Maddalena Cordioli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Amina Hançali
- STIs Laboratory, Department of Bacteriology, Institut National d'Hygiene, Ministry of Health- Morocco, Rabat, Morocco
| | - Ting-Ting Jiang
- Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, National Center for STD Control, Nanjing, China
| | - Ranmini Kularatne
- Centre for HIV & STI, National Institute for Communicable Diseases, Sandringham, South Africa
| | - Stephanie Meli
- Point-of-Care Testing Committee, Department of Pathology, Mater Dei Hospital, Msida, Malta
| | - Etienne Muller
- Centre for HIV & STI, National Institute for Communicable Diseases, Sandringham, South Africa
| | - Hicham Oumzil
- Pedagogy and Research Unit of Microbiology, Faculty of Medicine and Pharmacy, Mohammed V University -Rabat, Virology Department, Institut National d'Hygiène MoH, Rabat, Morocco
| | - Valeska Padovese
- Genito-Urinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
| | - Angela Sandri
- Department of Diagnosis and Public Health, Section of Microbiology, University of Verona, Verona, Italy
| | - Silver Vargas
- Centro de Investigación Interdisciplinaria en Sexualidad SIDA y Sociedad, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Graziella Zahra
- Molecular Diagnostics Infectious Diseases, Department of Pathology, Mater Dei Hospital, Msida, Malta
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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7
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Cao W, Fakile YF, Shukla MR, Pettus K, Lupoli K, Hong J, Pillay A, Kularatne R, Oumzil H, Padovese V, Sherriff N, SSewanyana I, Vargas SK, Zorzi A, Blondeel K, Toskin I, Kersh EN. External quality assessment to support the WHO ProSPeRo study for the evaluation of two dual HIV/syphilis point-of-care tests in seven countries. BMC Infect Dis 2024; 24:194. [PMID: 38418989 PMCID: PMC10902925 DOI: 10.1186/s12879-024-09027-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/17/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) such as syphilis and HIV remain to be a significant public health issue worldwide. Dual rapid point-of-care tests (POCTs) have shown promise for detecting antibodies to HIV and syphilis but have not been fully evaluated in the field. Our study supported the WHO ProSPeRo study on Sexually Transmitted Infection Point-of-Care Testing (STI POCT) by providing external quality assessment (EQA) for HIV and syphilis testing in reference laboratories and their associated clinical sites in seven countries. METHODS HIV/syphilis serum liquid and dried tube specimen (DTS) panels were prepared by CDC. Liquid panels were distributed to the reference laboratories for three rounds of testing using commercially and locally available laboratory-based serological tests. DTS panels were sent to the clinical testing sites for 8 rounds of POC testing using the Abbott SD BIOLINE HIV/Syphilis Duo test (hereafter referred to as SD BIOLINE) and the Chembio Dual Path Platform (DPP) HIV-Syphilis assay. EQA panels were tested at CDC using the Rapid Plasma Reagin (RPR) test and the Treponema pallidum Particle Agglutination assay (TP-PA) for syphilis antibodies. Genetic Systems HIV-1/HIV-2 Plus O EIA, Geenius HIV Supplemental Assay and the Oraquick Advance HIV test were used to detect HIV antibodies in the EQA panels. Results from the reference laboratories and POCT sites were compared to those obtained at the CDC and a percentage agreement was calculated. RESULTS Qualitative RPR and TP-PA performed at the reference laboratories demonstrated 95.4-100% agreement with CDC results while quantitative RPR and TP-PA tests demonstrated 87.7% and 89.2% agreement, respectively. A 93.8% concordance rate was observed for qualitative HIV testing in laboratories. EQA testing at clinical sites using dual tests showed 98.7% and 99.1% agreement for detection of HIV antibodies and eight out of 10 sites had > 95.8% agreement for syphilis testing. However, two clinical sites showed only 65.0-66.7% agreement for SD BIOLINE and 84.0-86.7% for DPP, respectively, for syphilis testing. CONCLUSIONS Overall, laboratories demonstrated high EQA performance in this study. Both HIV/syphilis POCTs gave expected results in the clinic-based evaluations using DTS. However, testing errors were identified in a few testing sites suggesting the necessity for continuous training and monitoring the quality of POC testing.
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Affiliation(s)
- Weiping Cao
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
| | - Yetunde F Fakile
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Mayur R Shukla
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Kevin Pettus
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Kathryn Lupoli
- Division of Global HIV &TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jaeyoung Hong
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Allan Pillay
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Ranmini Kularatne
- Centre for HIV & STI, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Hicham Oumzil
- National Reference Laboratory for HIV, Virology Department, National Institute of Hygiene, and Pedagogy and Research Unit of Microbiology, School of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Valeska Padovese
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, 2090, Malta
| | - Nigel Sherriff
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Isaac SSewanyana
- Central Public Health Laboratories, Ministry of Health, Plot 1062, 106 Old Butabika Rd, Kampala, Uganda
| | - Silver K Vargas
- Center for Interdisciplinary Research in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonella Zorzi
- Virology and Microbiology Unit, Department of Pathology and Diagnostics, Verona University Hospital, Verona, Italy
- Virology and Microbiology Unit, Department of Molecular Medicine, Padua University Hospital, Padua, Italy
| | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Ellen N Kersh
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
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8
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Shipitsyna E, Kularatne R, Golparian D, Müller EE, Vargas SK, Hadad R, Padovese V, Hancali A, Alvarez CS, Oumzil H, Camey E, Blondeel K, Toskin I, Unemo M. Mycoplasma genitalium prevalence, antimicrobial resistance-associated mutations, and coinfections with non-viral sexually transmitted infections in high-risk populations in Guatemala, Malta, Morocco, Peru and South Africa, 2019-2021. Front Microbiol 2023; 14:1130762. [PMID: 36910203 PMCID: PMC9994645 DOI: 10.3389/fmicb.2023.1130762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
The prevalence of Mycoplasma genitalium (MG) and MG antimicrobial resistance (AMR) appear to be high internationally, however, prevalence data remain lacking globally. We evaluated the prevalence of MG and MG AMR-associated mutations in men who have sex with men (MSM) in Malta and Peru and women at-risk for sexually transmitted infections in Guatemala, South Africa, and Morocco; five countries in four WHO regions mostly lacking MG prevalence and AMR data, and estimated MG coinfections with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV). Male urine and anorectal samples, and vaginal samples were tested for MG, CT, NG, and TV (only vaginal samples) using Aptima assays (Hologic). AMR-associated mutations in the MG 23S rRNA gene and parC gene were identified using ResistancePlus MG kit (SpeeDx) or Sanger sequencing. In total, 1,425 MSM and 1,398 women at-risk were recruited. MG was detected in 14.7% of MSM (10.0% in Malta and 20.0% Peru) and in 19.1% of women at-risk (12.4% in Guatemala, 16.0% Morocco, 22.1% South Africa). The prevalence of 23S rRNA and parC mutations among MSM was 68.1 and 29.0% (Malta), and 65.9 and 5.6% (Peru), respectively. Among women at-risk, 23S rRNA and parC mutations were revealed in 4.8 and 0% (Guatemala), 11.6 and 6.7% (Morocco), and 2.4 and 3.7% (South Africa), respectively. CT was the most frequent single coinfection with MG (in 2.6% of MSM and 4.5% of women at-risk), compared to NG + MG found in 1.3 and 1.0%, respectively, and TV + MG detected in 2.8% of women at-risk. In conclusion, MG is prevalent worldwide and enhanced aetiological MG diagnosis, linked to clinical routine detection of 23S rRNA mutations, in symptomatic patients should be implemented, where feasible. Surveillance of MG AMR and treatment outcome would be exceedingly valuable, nationally and internationally. High levels of AMR in MSM support avoiding screening for and treatment of MG in asymptomatic MSM and general population. Ultimately, novel therapeutic antimicrobials and/or strategies, such as resistance-guided sequential therapy, and ideally an effective MG vaccine are essential.
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Affiliation(s)
- Elena Shipitsyna
- World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Medical Microbiology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, St. Petersburg, Russia
| | - Ranmini Kularatne
- Labtests Laboratory and Head Office, Mt Wellington, Auckland, New Zealand.,Department of Clinical Microbiology & Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel Golparian
- World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Etienne E Müller
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Silver K Vargas
- School of Public Health and Administration, Centre for Interdisciplinary Investigation in Sexuality, AIDS, Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ronza Hadad
- World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Valeska Padovese
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
| | - Amina Hancali
- STIs Laboratory, National Institute of Hygiene, Ministry of Health, Rabat, Morocco
| | | | - Hicham Oumzil
- STIs Laboratory, National Institute of Hygiene, Ministry of Health, Rabat, Morocco.,Faculty of Medicine and Pharmacy, University Mohamed V, Rabat, Morocco
| | - Elsy Camey
- Sida y Sociedad ONG (SISO), Escuintla, Guatemala
| | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Magnus Unemo
- World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Institute for Global Health, University College London (UCL), London, United Kingdom
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9
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Zhang Y, Goh SM, Mello MB, Baggaley RC, Wi T, Johnson CC, Asiedu KB, Marks M, Pham MD, Fairley CK, Chow EPF, Mitjà O, Toskin I, Ballard RC, Ong JJ. Improved rapid diagnostic tests to detect syphilis and yaws: a systematic review and meta-analysis. Sex Transm Infect 2022; 98:608-616. [PMID: 36180209 PMCID: PMC9685714 DOI: 10.1136/sextrans-2022-055546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Current rapid tests for syphilis and yaws can detect treponemal and non-treponemal antibodies. We aimed to critically appraise the literature for rapid diagnostic tests (RDTs) which can better distinguish an active infection of syphilis or yaws. METHODS We conducted a systematic review and meta-analysis, searching five databases between January 2010 and October 2021 (with an update in July 2022). A generalised linear mixed model was used to conduct a bivariate meta-analysis for the pooled sensitivity and specificity. Heterogeneity was assessed using the I2 statistic. We used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) to assess the risk of bias and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) to evaluate the certainty of evidence. RESULTS We included 17 studies for meta-analyses. For syphilis, the pooled sensitivity and specificity of the treponemal component were 0.93 (95% CI: 0.86 to 0.97) and 0.98 (95% CI: 0.96 to 0.99), respectively. For the non-treponemal component, the pooled sensitivity and specificity were 0.90 (95% CI: 0.82 to 0.95) and 0.97 (95% CI: 0.92 to 0.99), respectively. For yaws, the pooled sensitivity and specificity of the treponemal component were 0.86 (95% CI: 0.66 to 0.95) and 0.97 (95% CI: 0.94 to 0.99), respectively. For the non-treponemal component, the pooled sensitivity and specificity were 0.80 (95% CI: 0.55 to 0.93) and 0.96 (95% CI: 0.92 to 0.98), respectively. CONCLUSIONS RDTs that can differentiate between active and previously treated infections could optimise management by providing same-day treatment and reducing unnecessary treatment. PROSPERO REGISTRATION NUMBER CRD42021279587.
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Affiliation(s)
- Ying Zhang
- School of Public Health, The University of Sydney, Campertown, New South Wales, Australia
| | - Su Mei Goh
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
| | - Maeve B Mello
- Global HIV, Hepatitis and STI Programmes, WHO, Geneva, Switzerland
| | | | - Teodora Wi
- Global HIV, Hepatitis and STI Programmes, WHO, Geneva, Switzerland
| | - Cheryl C Johnson
- Global HIV, Hepatitis and STI Programmes, WHO, Geneva, Switzerland
| | | | - Michael Marks
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK,Hospital for Tropical Diseases, University College London Hospital, London, UK,Division of Infection and Immunity, University College London, London, UK
| | - Minh D Pham
- Burnet Institute, Melbourne, Victoria, Australia,School of Public Health and Preventive Medicine, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Oriol Mitjà
- Fight AIDS and Infectious Diseases Foundation, Catalonia, Spain
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Ronald C Ballard
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Jason J Ong
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia,Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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10
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Björndahl L, Barratt CLR, Mortimer D, Agarwal A, Aitken RJ, Alvarez JG, Aneck-Hahn N, Arver S, Baldi E, Bassas L, Boitrelle F, Bornman R, Carrell DT, Castilla JA, Cerezo Parra G, Check JH, Cuasnicu PS, Darney SP, de Jager C, De Jonge CJ, Drevet JR, Drobnis EZ, Du Plessis SS, Eisenberg ML, Esteves SC, Evgeni EA, Ferlin A, Garrido N, Giwercman A, Goovaerts IGF, Haugen TB, Henkel R, Henningsohn L, Hofmann MC, Hotaling JM, Jedrzejczak P, Jouannet P, Jørgensen N, Kirkman Brown JC, Krausz C, Kurpisz M, Kvist U, Lamb DJ, Levine H, Loveland KL, McLachlan RI, Mahran A, Maree L, Martins da Silva S, Mbizvo MT, Meinhardt A, Menkveld R, Mortimer ST, Moskovtsev S, Muller CH, Munuce MJ, Muratori M, Niederberger C, O’Flaherty C, Oliva R, Ombelet W, Pacey AA, Palladino MA, Ramasamy R, Ramos L, Rives N, Roldan ER, Rothmann S, Sakkas D, Salonia A, Sánchez-Pozo MC, Sapiro R, Schlatt S, Schlegel PN, Schuppe HC, Shah R, Skakkebæk NE, Teerds K, Toskin I, Tournaye H, Turek PJ, van der Horst G, Vazquez-Levin M, Wang C, Wetzels A, Zeginiadou T, Zini A. Standards in semen examination: publishing reproducible and reliable data based on high-quality methodology. Hum Reprod 2022; 37:2497-2502. [PMID: 36112046 PMCID: PMC9627864 DOI: 10.1093/humrep/deac189] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/01/2022] [Indexed: 07/30/2023] Open
Abstract
Biomedical science is rapidly developing in terms of more transparency, openness and reproducibility of scientific publications. This is even more important for all studies that are based on results from basic semen examination. Recently two concordant documents have been published: the 6th edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen, and the International Standard ISO 23162:2021. With these tools, we propose that authors should be instructed to follow these laboratory methods in order to publish studies in peer-reviewed journals, preferable by using a checklist as suggested in an Appendix to this article.
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Affiliation(s)
- Lars Björndahl
- Correspondence address. Andrology Laboratory, ANOVA, Karolinska University Hospital and Karolinska Institutet, Norra Stationsgatan 69, level 4, S-113 64 Stockholm, Sweden. E-mail:
| | | | | | - Ashok Agarwal
- Case Western Reserve University, Moreland Hills, OH, USA
| | - Robert J Aitken
- Priority Research Centre for Reproductive Science, Faculty of Science and Faculty of Health & Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Juan G Alvarez
- Centro Androgen, La Coruña, Spain
- Harvard Medical School, Boston, MA, USA
| | | | - Stefan Arver
- ANOVA, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Elisabetta Baldi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Tuscany, Italia
| | - Lluís Bassas
- Andrology Department, Laboratory of Andrology and Sperm Bank, Fundació Puigvert, Barcelona, Spain
| | - Florence Boitrelle
- Department of Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
- Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Riana Bornman
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Douglas T Carrell
- Andrology and IVF Laboratory, Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - José A Castilla
- GAMETIA Biobank, Granada, Spain
- Hospital Universitario Virgen de las Nieves and Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Gerardo Cerezo Parra
- LAFER Sperm Bank, Tuxpan 10-606, Roma Sur, C.P. 06760, Cuauhtémoc, Mexico City, Mexico
| | - Jerome H Check
- Robert Wood Johnson Medical School at Camden, The University of Medicine and Dentistry of New Jersey, Camden, NJ, USA
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, Cooper Hospital/University Medical Center, Melrose Park, PA, USA
| | - Patricia S Cuasnicu
- Instituto de Biología y Medicina Experimental (IbyME-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Joël R Drevet
- Université Clermont Auvergne/CNRS/INSERM-GreD Institute, Clermont-Ferrand, France
| | - Erma Z Drobnis
- School of Medicine, University of Missouri, Columbia, MI, USA
| | - Stefan S Du Plessis
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Michael L Eisenberg
- Male Reproductive Medicine and Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
- Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus C, Denmark
| | - Evangelini A Evgeni
- CRYOGONIA Cryopreservation Bank, Athens, Greece
- Laboratory of Physiology, Department of Medicine, Democritus University of Thrace, Greece
| | - Alberto Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italia
| | - Nicolas Garrido
- IVI Foundation, Health Research Institute La Fe, Valencia, Spain
| | | | | | - Trine B Haugen
- Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway
| | - Ralf Henkel
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | - Lars Henningsohn
- Division of Urology, Department of CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Marie-Claude Hofmann
- Department of Endocrine Neoplasia & Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Piotr Jedrzejczak
- Department of Cell Biology, Poznan University of Medical Science, Poznan, Poland
| | | | - Niels Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jackson C Kirkman Brown
- Centre for Human Reproductive Science (ChRS), UK
- College of Medical & Dental Sciences, University of Birmingham, UK
- Birmingham Women’s and Children’s NHS Foundation Trust, UK
| | - Csilla Krausz
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Maciej Kurpisz
- Department of Reproductive Biology and Stem Cells, Institutet of Human Genetics, Poznan, Poland
| | - Ulrik Kvist
- ANOVA, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Dolores J Lamb
- Brady Department of Urology, Center for Reproductive Genomics and Englander Institute for Precision Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kate L Loveland
- Hudson Institute, Centre for Reproductive Health, Monash University, Clayton, VIC, Australia
| | - Robert I McLachlan
- Hudson Institute of Medical Research, Centre for Endocrinology and Metabolism, Monash University, Clayton, VIC, Australia
| | - Ali Mahran
- Dermatology and Andrology Department, Assiut University Hospital, Assiut, Egypt
- Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Liana Maree
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | - Sarah Martins da Silva
- Reproductive Medicine Research Group, Division of Systems Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | | | - Andreas Meinhardt
- Department of Anatomy and Cell Biology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Roelof Menkveld
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Sharon T Mortimer
- Oozoa Biomedical Inc., West Vancouver, BC, Canada
- Division of REI, Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sergey Moskovtsev
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
- CreATe Fertility Centre, Toronto, ON, Canada
| | - Charles H Muller
- Male Fertility Laboratory, Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Maria José Munuce
- Laboratorio de Medicina Reproductiva, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Argentina
| | - Monica Muratori
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Craig Niederberger
- Department of Urology, UIC College of Medicine, IL, USA
- Department of Bioengineering, UIC College of Engineering, IL, USA
| | - Cristian O’Flaherty
- Department of Surgery (Urology Division), McGill University, Montréal, QC, Canada
| | - Rafael Oliva
- Molecular Biology of Reproduction and Development Group, Biomedical Research Institute August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Willem Ombelet
- Genk Institute for Fertility Technology, Genk, Belgium
- Department of Obstetrics and Gynaecology, ZOL Hospitals and Hasselt University, Genk, Belgium
| | - Allan A Pacey
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Liliana Ramos
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecologie, Radboud UMC, Nijmegen, The Netherlands
| | - Nathalie Rives
- Service Laboratoire de Biologie de la Reproduction-CECOS, Equipe Physiopathologie Surrénalienne et Gonadique, Unité Inserm 1239 NorDic, CHU-Hôpitaux de Rouen, UFR Santé—Université de Rouen, Rouen, France
| | - Eduardo Rs Roldan
- Department of Biodiversity and Evolutionary Biology, Museo Nacional de Ciencias Naturales (CSIC), Madrid, Spain
| | | | | | - Andrea Salonia
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Maria Cristina Sánchez-Pozo
- Department of Clinical Chemistry and Molecular Biology, Virgen del Rocío University Hospital, Seville, Spain
| | - Rosanna Sapiro
- Depto de Histologia y Embriología, Facultad de Medicina, Gral. Flores, Uruguay
| | - Stefan Schlatt
- Centre of Reproductive Medicine and Andrology, Münster, Germany
| | - Peter N Schlegel
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Hans-Christian Schuppe
- Section of Andrology, Department of Urology, Pediatric Urology & Andrology, Justus-Liebig-University/University Hospital of Giessen-Marburg, Giessen, Germany
| | - Rupin Shah
- Lilavati Hospital & Research Centre, Mumbai, India
| | - Niels E Skakkebæk
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Katja Teerds
- Human and Animal Physiology, Wageningen University, Wageningen, The Netherlands
| | - Igor Toskin
- WHO Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction—HRP), Geneva, Switzerland
| | - Herman Tournaye
- Centre for Reproductive Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Gerhard van der Horst
- Medical Bioscience, University of the Western Cape, Bellville, South Africa
- Physiology Medical School, Stellenbosch University, Stellenbosch, South Africa
- Department of Animal Science, Stellenbosch University, Stellenbosch, South Africa
| | | | - Christina Wang
- Clinical and Translational Science Institute, The Lundquist Institute, Torrance, CA, USA
- Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Alex Wetzels
- Fertility Laboratory, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Theodosia Zeginiadou
- Thessaloniki Andrology Laboratory—Hellenic Sperm Bank, Thessaloniki, Greece
- Laboratory of Histology-Embryology, Medical School, University of Athens, Athens, Greece
| | - Armand Zini
- Division of Urology, Department of Surgery, St Mary's Hospital, McGill University, Montreal, Canada
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11
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Barratt CLR, Wang C, Baldi E, Toskin I, Kiarie J, Lamb DJ. What advances may the future bring to the diagnosis, treatment, and care of male sexual and reproductive health? Fertil Steril 2022; 117:258-267. [PMID: 35125173 PMCID: PMC8877074 DOI: 10.1016/j.fertnstert.2021.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 12/11/2022]
Abstract
Over the past 40 years, since the publication of the original WHO Laboratory Manual for the Examination and Processing of Human Semen, the laboratory methods used to evaluate semen markedly changed and benefited from improved precision and accuracy, as well as the development of new tests and improved, standardized methodologies. Herein, we present the impact of the changes put forth in the sixth edition together with our views of evolving technologies that may change the methods used for the routine semen analysis, up-and-coming areas for the development of new procedures, and diagnostic approaches that will help to extend the often-descriptive interpretations of several commonly performed semen tests that promise to provide etiologies for the abnormal semen parameters observed. As we look toward the publication of the seventh edition of the manual in approximately 10 years, we describe potential advances that could markedly impact the field of andrology in the future.
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Affiliation(s)
- Christopher L R Barratt
- Division of Systems Medicine, University of Dundee Medical School, Ninewells Hospital, Dundee, Scotland.
| | - Christina Wang
- Clinical and Translational Science Institute, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Elisabetta Baldi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - James Kiarie
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Dolores J Lamb
- The James Buchanan Brady Foundation Department of Urology, Center for Reproductive Genomics and Englander Institute for Personalized Medicine, Weill Cornell Medical College, New York, New York
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12
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Jiron JP, Sandoval C, Enciso JC, De Vasconcelos AS, Blondeel K, Bakunina N, Lesco G, Toskin I, Stephenson R, Caceres CF. Correction to: Brief intervention to prevent HIV, STI and unintended pregnancies: preliminary results of a feasibility study from the perspective of healthcare providers in Peru. BMC Health Serv Res 2021; 21:1366. [PMID: 34961535 PMCID: PMC8713391 DOI: 10.1186/s12913-021-07417-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jean Pierre Jiron
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Clara Sandoval
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Carlos Enciso
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ana Sofía De Vasconcelos
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Nataliia Bakunina
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.,Institute for Leadership and Health Management, I.M, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Galina Lesco
- National Resource Centre in Youth Friendly Health Services NEOVITA, Chisinau, Republic of Moldova
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Rob Stephenson
- Department of Systems, Population and Leadership, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA.,Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, USA
| | - Carlos F Caceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
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13
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Otu A, Danhoundo G, Toskin I, Govender V, Yaya S. Refocusing on sexually transmitted infections (STIs) to improve reproductive health: a call to further action. Reprod Health 2021; 18:242. [PMID: 34852842 PMCID: PMC8634744 DOI: 10.1186/s12978-021-01296-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Akaninyene Otu
- Department of Infection and Travel Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Georges Danhoundo
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Veloshnee Govender
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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Jiron JP, Sandoval C, Enciso JC, De Vasconcelos AS, Blondeel K, Bakunina N, Lesco G, Toskin I, Stephenson R, Caceres CF. Brief intervention to prevent HIV, STI and unintended pregnancies: preliminary results of a feasibility study from the perspective of healthcare providers in Peru. BMC Health Serv Res 2021; 21:1225. [PMID: 34772418 PMCID: PMC8590268 DOI: 10.1186/s12913-021-07229-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Brief interventions have proven to be valuable instruments for the treatment and care of clients with diverse health needs, due to their potential to impact both the individual and the population. In this regard, the Brief Sexuality-Related Communication (BSC) is presented as a viable and effective alternative for addressing sexual and reproductive health problems, assessing risk behaviors and motivating clients to generate behavioral change. Since health providers are key actors in treatment and prevention, it is essential to know their perceptions about the BSC intervention, as well as its acceptability in different contexts, with diverse client populations. Thus, the following paper reflects the findings of the perceptions and experiences of health providers in Peru from the first phase of the Feasibility study of a BSC intervention to prevent STIs and unintended pregnancies. Methods This is the first phase of a multisite and multiphase study of the feasibility of a BSC intervention. We conducted twenty in-depth interviews (IDI) with health care providers (physicians, obstetricians, psychologists, nurses and peer counselors) recruited from three health care institutions in Peru: The Tahuantinsuyo Bajo Maternal and Child Center (CMI) and the San José Maternal and Child Center, both located in the capital city, Lima; and La Caleta Hospital located in Chimbote, northern coast of Peru. Participating health providers included those working at the HIV/STI Reference service and the family planning/reproductive health service. The IDI addressed three domains: 1) Acceptability of the BSC intervention; 2) Perceived willingness to implement the BSC intervention; and 3) Considerations for the Implementation of the BSC intervention. Results Health providers expressed high acceptance of the BSC intervention, considering it as a useful and effective instrument to address sexual and reproductive health problems with all clients; however, some providers had some concerns about the real impact of the intervention to achieve significant behavior change. On the other hand, health providers showed high willingness to learn and implement the BSC intervention, affirming their commitment to learn new techniques and strategies that could allow them to improve their knowledge and the quality of their care. Health care providers consider it necessary to take into account the barriers that arise in the implementation of the BSC intervention, such as the structural limitations to access, the providers’ abilities to deliver the intervention effectively, and the participants’ reception of the intervention. Finally, providers consider it essential to establish the BSC intervention in a normative framework that allows it to receive the support of the health departments and eventually enforces implementation. Conclusions Health providers consider the BSC intervention as an interesting and exciting behavioral intervention to deal with the sexual and reproductive health issues existing in different populations, and seemed highly willing to adapt and implement it, hoping that it become beneficial to all client populations to prevent HIV/STIs and unintended pregnancies.
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Affiliation(s)
- Jean Pierre Jiron
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Clara Sandoval
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Carlos Enciso
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ana Sofía De Vasconcelos
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Nataliia Bakunina
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.,Institute for Leadership and Health Management, I.M, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Galina Lesco
- National Resource Centre in Youth Friendly Health Services NEOVITA, Chisinau, Republic of Moldova
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Rob Stephenson
- Department of Systems, Population and Leadership, School of Nursing, University of Michigan, Ann Arbor, USA.,Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
| | - Carlos F Caceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
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Murtagh M, Blondeel K, Peeling RW, Kiarie J, Toskin I. The relevance of target product profiles for manufacturers, experiences from the World Health Organization initiative for point-of-care testing for sexually transmitted infections. Arch Public Health 2021; 79:187. [PMID: 34706763 PMCID: PMC8549211 DOI: 10.1186/s13690-021-00708-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background Sexually transmitted infections (STIs) are a significant global public health issue that cause a high burden of disease, especially in low- and middle-income countries. Screening of key populations and early and accurate diagnosis of infection are critical. Testing for syphilis, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, curable STIs, as well as the human papillomavirus (HPV), is frequently unavailable in low-resource settings. Tests for these STIs that can be used at the point of patient care (POCTs) are needed. In recent years, there has been increased attention for STI POCTs, but technical guidance, financial resources and advocacy for additional platforms/tests are required in order to foster the development of STI POCTs. The WHO Department of Sexual and Reproductive Health and Research (SRH) has developed target product profiles (TPPs), a form of technical guidance, for these STI diagnostics. Methods SRH conducted a survey of selected companies that are developing POCTs for one or more of the STIs mentioned above to better understand how these TPPs influence the diagnostic development process – to assess their impact. Results Survey respondents indicated that the STI POCT TPPs provided good guidance with respect to performance expectations and operational characteristics for the tests/platforms. In particular, optimal metrics for sensitivity, specificity, sample types, and time to result were considered to be very useful. Respondents also suggested ways to improve the relevance of the STI POCT TPPs. For example, since it is often not possible for developers to achieve every desired standard, it would be useful to prioritize each performance/operational characteristic of the test and to provide a rationale as to why certain characteristics are considered important. Respondents also emphasized the need to encourage industry participation in the TPP development process and to find creative ways, including via targeted emails, a WHO webpage directed at industry, or a coordinated communications plan to increase awareness of the TPPs. Conclusions Companies value the STI POCT TPPs and want them to continue. In order to maximize impact, WHO should consider the proposals from the manufacturers in the interest of increasing and accelerating access to STI diagnostics and treatment in low-resource settings.
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Affiliation(s)
- Maurine Murtagh
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Karel Blondeel
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland. .,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | | | - James Kiarie
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Igor Toskin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Johnston LG, McLaughlin KR, Gios L, Cordioli M, Staneková DV, Blondeel K, Toskin I, Mirandola M. Populations size estimations using SS-PSE among MSM in four European cities: how many MSM are living with HIV? Eur J Public Health 2021; 31:1129-1136. [PMID: 34626188 DOI: 10.1093/eurpub/ckab148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although men who have sex with men (MSM) are considered at high risk for transmission of sexually transmitted infections, including HIV, there are few studies estimating the population size of MSM in Europe. We used network data from a survey of MSM in four cities to perform successive sampling-population size estimations (SS-PSE) to estimate MSM population sizes. METHODS Data were collected in 2013-14 in Bratislava, Bucharest, Verona and Vilnius using respondent-driven sampling (RDS). SS-PSE uses a Bayesian framework to approximate the RDS sampling structure via a successive sampling model and uses the selection order of the sample to provide information about the distribution of network sizes over the population members of MSM. RESULTS We estimate roughly 4600 MSM in Bratislava, 25 300 MSM in Bucharest, 7200 in Verona and 2900 in Vilnius. This represents 2.9% of the estimated adult male population in Bratislava, 2.3% in Bucharest, 2.7% in Verona and 1.5% in Vilnius. The number of MSM living with HIV would roughly be 200 in Bratislava, 4554 in Bucharest, 690 in Verona and 100 in Vilnius. CONCLUSIONS Benefits of this method are that no additional information from an RDS survey needs to be collected, that the sizes can be calculated ex post facto a survey and that there is a software programme that can run the SS-PSE models. However, this method relies on having reliable priors. Although many countries are estimating the sizes of their vulnerable populations, European countries have yet to incorporate similar and novel methods.
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Affiliation(s)
| | | | - Lorenzo Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Maddalena Cordioli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research, SRH, World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, SRH, World Health Organization, Geneva, Switzerland
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.,School of Health Sciences, University of Brighton, Brighton, UK
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Stephenson R, Lesco G, Babii V, Luchian A, Bakunina N, De Vasconcelos AS, Blondeel K, Cáceres CF, Pitter RA, Metheny N, Goldenberg T, Kiarie J, Toskin I. Provider attitudes towards a brief behavioral intervention for sexual health in Moldova. BMC Public Health 2021; 21:1469. [PMID: 34320985 PMCID: PMC8317477 DOI: 10.1186/s12889-021-11490-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/05/2021] [Indexed: 12/05/2022] Open
Abstract
Background Brief behavioral interventions are seen as an efficient way to improve knowledge, change behavior, and reduce provider stigma regarding sexual health. When grounded in evidence-based behavioral change techniques and delivered using Brief Sexuality-related Communication (BSC) tools, brief behavioral interventions can address client-driven sexual health goals in a single session with their provider. Evidence for the efficacy of brief interventions for creating gains in sexual health comes largely from resource rich settings, and there is a lack of knowledge of how brief interventions can be implemented in the more resource constrained environments of low- and middle-income countries. As a first step in developing a brief intervention to address sexual health issues in Moldova, this paper reports on qualitative data collected from Moldovan providers to understand their attitudes, willingness and perceived barriers to the brief intervention and its implementation. Methods Thirty-nine in-depth interviews (IDI) were conducted between February and March 2020, with health providers recruited from three primary health care institutions, two Youth Friendly Health Centers and counselors from three NGOs who work with key populations in Moldova, including health centers selected from two cites - the capital city, Chisinau and from the Comrat Region. The IDI addressed four domains of provider attitudes: 1) attitudes towards the intervention; 2) willingness and motivation to implement the intervention; 3) logistics of providing the intervention and 4) ability to implement the intervention. A coding analysis approach was applied to all interview transcripts. Results Providers largely reported being willing to be trained in and implement the brief intervention. Willingness to implement the intervention stemmed from two perceptions: that it would improve the ability of providers to talk with their clients about sex, and that vulnerable groups would benefit from these conversations. However, while there were generally positive attitudes towards the intervention, providers consistently reported structural barriers to their perceived ability to implement the intervention. Conclusions While providers reported high levels of initial acceptance of a brief behavioral intervention, care is needed to ensure that brief interventions, and the training of providers on brief interventions, incorporate cultural attitudes and norms around sex, particularly in highly patriarchal settings, and provide opportunities for providers to practice the intervention in ways that address their assumptions and implicit biases.
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Affiliation(s)
- Rob Stephenson
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, USA. .,Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA.
| | - Galina Lesco
- National Resource Centre in Youth Friendly Health Services NEOVITA, Chisinau, Republic of Moldova
| | - Viorel Babii
- National Resource Centre in Youth Friendly Health Services NEOVITA, Chisinau, Republic of Moldova
| | - Andrei Luchian
- National Resource Centre in Youth Friendly Health Services NEOVITA, Chisinau, Republic of Moldova
| | - Nataliia Bakunina
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Ana Sofia De Vasconcelos
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Karel Blondeel
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Carlos F Cáceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Renée A Pitter
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
| | - Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Tamar Goldenberg
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James Kiarie
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Igor Toskin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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18
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Sherriff NS, Jones AM, Mirandola M, Gios L, Marcus U, Llewellyn C, Rosinska M, Folch C, Dias S, Toskin I, Alexiev I, Kühlmann-Berenzon S. Factors related to condomless anal intercourse between men who have sex with men: results from a European bio-behavioural survey. J Public Health (Oxf) 2021; 42:e174-e186. [PMID: 31090894 PMCID: PMC7251420 DOI: 10.1093/pubmed/fdz052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/17/2019] [Indexed: 12/11/2022] Open
Abstract
Background Relationship status is an important factor associated with condomless anal intercourse (CAI) amongst men who have sex with men (MSM). Methods A multi-centre bio-behavioural survey with MSM was conducted in 13 European cities (n = 4901) exploring factors associated with CAI via bivariate and multivariate multilevel logistic regression analyses. Results Likelihood of CAI with casual partners was associated with being ‘out’ to a majority (AOR = 1.19;95% CI 1,1.42); knowing their HIV status (AOR = 1.86; 95% CI 1.25,2.76); using substances (1–2 AOR = 1.39; 95% CI 1.16,1.63, 2+ AOR = 1.81; 95% CI 1.35,2.42); being older (AOR = 0.98; 95% CI 0.97,0.99); successful sero-communication (AOR = 0.79; 95% CI 0.67,0.94); and, not having a recent HIV test (AOR = 0.78; 95% CI 0.66,0.92). CAI with steady partners was associated with successful sero-communication (AOR = 2.72; 95% CI 2.72,3.66); not having a recent HIV test (AOR = 1.26; 95% CI 1.09,1.46), and; being older (AOR = 0.99; 95% CI 0.98,0.99). Conclusions Understandings of partner type and/or relationship status in relation to CAI amongst MSM can potentially play an important role in the development of culturally appropriate HIV/STI prevention and risk-reduction efforts targeting at-risk MSM. Our results speak to the need to consider segmented and tailored public health and health promotion initiatives for MSM with differing CAI behaviours and relationship profiles.
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Affiliation(s)
- N S Sherriff
- School of Health Sciences, University of Brighton, Brighton, BN1 9PH, UK.,Centre for Transforming Sexuality & Gender, University of Brighton, Brighton, Brighton, BN1 9PH, UK
| | - A M Jones
- School of Health Sciences, University of Brighton, Brighton, BN1 9PH, UK.,Research and Development Department, Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom, BN13 3EP, UK
| | - M Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - L Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - U Marcus
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - C Llewellyn
- Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PH, UK
| | - M Rosinska
- National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - C Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya / CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - S Dias
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública & GHTM, Universidade NOVA de Lisboa, Portugal
| | - I Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - I Alexiev
- National Reference Laboratory of HIV, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - S Kühlmann-Berenzon
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
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19
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Vargas S, Calvo G, Qquellon J, Vasquez F, Blondel K, Ballard R, Toskin I. Point-of-care testing for sexually transmitted infections in low-resource settings. Clin Microbiol Infect 2021; 28:946-951. [PMID: 34118424 DOI: 10.1016/j.cmi.2021.05.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/07/2021] [Accepted: 05/31/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Both the global incidence and prevalence of sexually transmitted infections continue to increase, affecting hundreds of millions of individuals, particularly in low-to middle-income countries. While a definitive diagnosis is desirable to inform STI treatment, syndromic management is the most widely used strategy in resource-limited settings. With the development of point-of-care (POC) tests, it is important to discuss how laboratories will need to adapt to new training and supervisory roles in support of testing which will largely be performed by peripheral clinical staff. OBJECTIVES To discuss potential applications of STI POC tests, how they could improve existing STI control strategies and the role of clinical and reference laboratories in support of initiatives to improve STI management and control activities. SOURCES Narrative literature review and expert opinion. CONTENT The paper outlines the current status of the STI epidemic worldwide and discusses the problems associated with current approaches to control these infections, particularly in low resource settings. The roles of clinical and reference laboratories will need to change in order to provide support for POC and near-patient STI testing as these technologies are introduced into clinical as well as laboratory settings. IMPLICATIONS Laboratories will be expected to play a leading role in the introduction and implementation of POC and near-patient STI testing. They will be required to facilitate training and provide technical and supervisory support to clinical staff on the use of these technologies to augment existing STI management and surveillance programs. In order to provide quality service, they will need to develop, introduce and maintain sustainable local QC and EQA systems. Evidence from implementation research for introduction and scale up of STI POCTs in different STI epidemic and laboratory infrastructure settings is required.
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Affiliation(s)
- Silver Vargas
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru; Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gino Calvo
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jazmin Qquellon
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francesca Vasquez
- Center for Interdisciplinary Investigation in Sexuality, AIDS, and Society and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Karel Blondel
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Ronald Ballard
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Igor Toskin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
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20
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Campbell MJ, Lotti F, Baldi E, Schlatt S, Festin MPR, Björndahl L, Toskin I, Barratt CLR. Distribution of semen examination results 2020 - A follow up of data collated for the WHO semen analysis manual 2010. Andrology 2021; 9:817-822. [PMID: 33528873 DOI: 10.1111/andr.12983] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND It is now 11 years since publication of the WHO 2010 guidelines for semen assessment values, and it is critical to determine whether they are still valid and/or whether they should be modified. OBJECTIVES To utilise data published since 2010 and combine these with data used in the 2010 assessment to provide an updated and more comprehensive representation of the fertile man. This may be utilised to present an updated distribution of values for use by WHO in 2021. MATERIALS AND METHODS Two specific analyses were performed namely, (1) Analysis 1: Examination of published data following publication of WHO 2010 [termed 2010-2020 data]. (2) Analysis 2: Examination of the data used to help formulate the 2010 distribution of values combined with the data from Analysis (1) [termed WHO 2020]. RESULTS In total, data from more than 3500 subjects, from twelve countries and five continents were analysed. The 5th centile values for concentration, motility and morphology are: 16 × 106 /ml, 30% progressive motility [42% total motility] and 4% normal forms. DISCUSSION This study presents substantial additional information to establish more comprehensive and globally applicable lower reference values for semen parameters for fertile men although they do not represent distinct limits between fertile and subfertile men. There are still data missing from many countries and, some geographical regions are not represented. Moreover, the number of subjects although significant is still relatively low (<4000). CONCLUSION These distributions of values now include semen analysis providing a more global representation of the fertile man. Increasing the number of subjects provides robust information that is also more geographically representative.
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Affiliation(s)
- Martin J Campbell
- Division of Systems Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland
| | - Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Elisabetta Baldi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefan Schlatt
- Centre of Reproductive Medicine and Andrology, University Hospital of Münster, Münster, Germany
| | - Mario P R Festin
- Department of Obstetrics and Gynaecology, University of the Philippines College of Medicine, Philippine General Hospital, Ermita, Manila, Philippines
| | - Lars Björndahl
- Andrology Laboratory, ANOVA - Karolinska University Hospital & Karolinska Instiutet, Stockholm, Sweden
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research (SRH), World Health Organization, Geneva, Switzerland
| | - Christopher L R Barratt
- Division of Systems Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland
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21
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Gios L, Mirandola M, Sherriff N, Toskin I, Blondeel K, Dias S, Staneková D, Folch C, Schink SB, Nöstlinger C, Berghe WV, Naseva E, Alexiev I. Being in the Closet. Correlates of Outness Among MSM in 13 European Cities. J Homosex 2021; 68:415-433. [PMID: 31483215 DOI: 10.1080/00918369.2019.1656033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Data for MSM continue to show a high risk of acquiring HIV-STIs. Within this population, outness seems to have an impact on both risk-taking and on health seeking behaviors. The objective of this study was to assess the relationship between socio-demographic, behavioral characteristics, testing behaviors, and outness level among MSM using data from a multi-center bio-behavioral cross-sectional study carried out in 13 EU cities. A multilevel analysis was conducted to identify factors associated with being open ("out") versus not being open ("in"). A total of 4,901 MSM were enrolled in the study and were classified as "out" in 71% of the cases. MSM "out" were more likely to report HIV testing and being reached by HIV prevention programs compared to MSM who were "in." The results confirm the key role of outness in relation to different healthy and risky behavior, ranging from testing to party-drug use.
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Affiliation(s)
- Lorenzo Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona , Verona, Italy
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona , Verona, Italy
| | - Nigel Sherriff
- School of Health Sciences, University of Brighton , Brighton, UK
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization , Geneva, Switzerland
| | - Karel Blondeel
- Department of Reproductive Health and Research, World Health Organization , Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium
| | - Sonia Dias
- Escola Nacional de Saúde Pública Universidade, Universidade NOVA de Lisboa, Centro de Investigação em Saúde Pública , Lisboa, Portugal
| | - Danica Staneková
- NRC for HIV/AIDS, Slovak Medical University , Bratislava, Slovak Republic
| | - Cinta Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Department Salut, Generalitat de Catalunya/CIBER Epidemiologia y Salud Pública (CIBERESP) , Barcelona, Spain
| | | | - Christiane Nöstlinger
- Department of Public Health, Institute of Tropical Medicine , Antwerp, Belgium
- Faculty of Psychology, University of Vienna , Vienna, Austria
| | - Wim Vanden Berghe
- Department of Public Health, Institute of Tropical Medicine , Antwerp, Belgium
- Scientific Institute of Public Health , Brussels, Belgium
| | - Emilia Naseva
- Faculty of Public Health, Medical University of Sofia , Sofia, Bulgaria
| | - Ivailo Alexiev
- National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases , Sofia, Bulgaria
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22
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Chiware TM, Vermeulen N, Blondeel K, Farquharson R, Kiarie J, Lundin K, Matsaseng TC, Ombelet W, Toskin I. IVF and other ART in low- and middle-income countries: a systematic landscape analysis. Hum Reprod Update 2021; 27:213-228. [PMID: 33238297 PMCID: PMC7903111 DOI: 10.1093/humupd/dmaa047] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/06/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Infertility affects 48.5 million couples worldwide with a prevalence estimated at 3.5-16.7% in low- and middle-income countries (LMIC), and as high as 30-40% in Sub-Saharan Africa. ART services are not accessible to the majority of these infertile couples due to the high cost of treatments in addition to cultural, religious and legal barriers. Infertility and childlessness, particularly in LMIC, have devastating consequences, which has resulted in considerable interest in developing affordable IVF procedures. However, there is a paucity of evidence on the safety, efficiency and ability to replicate techniques under different field conditions, and how to integrate more affordable ART options into existing infrastructures. OBJECTIVE AND RATIONALE This review was performed to investigate the current availability of IVF in LMIC and which other ART options are under development. This work will unfold the landscape of available and potential ART services in LMIC and is a key element in positioning infertility more broadly in the Global Public Health Agenda. SEARCH METHODS A systematic literature search was performed of articles and gray literature on IVF and other ART options in LMIC published between January 2010 and January 2020. We selected studies on IVF and other ART treatments for infertile couples of reproductive age (18-44 years) from LMIC. The review was limited to articles published after 2010, based on the recent evolution in the field of ART practices in LMIC over the last decade. Citations from high-income countries, including data prior to 2010 and focusing on specialized ART procedures, were excluded. The literature search included PubMed, Popline, CINHAL, EMBASE and Global Index Medicus. No restrictions were applied with regard to study design or language. Two reviewers independently screened the titles and abstracts, and extracted data. A search for gray literature was performed using the 'Google' search engine and specific databases (worldcat.org, greylit.org). In addition, the reference lists of included studies were assessed. OUTCOMES The search of the electronic databases yielded 3769 citations. After review of the titles and abstracts, 283 studies were included. The full texts were reviewed and a further 199 articles were excluded. The gray literature search yielded 586 citations, most of which were excluded after screening the title, and the remaining documents were excluded after full-text assessment due to duplicate entries, not from LMIC, not relevant or no access to the full document. Eighty-four citations were included as part of the review and separated into regions. The majority of the studies were observational and qualitative studies. In general, ART services are available and described in several LMIC, ranging from advanced techniques in China to basic introduction of IVF in some African countries. Efforts to provide affordable ART treatments are described in feasibility studies and efficacy studies; however, most citations were of low to very low quality. We found no studies from LMIC reporting the implementation of low-cost ART that is effective, accessible and affordable to most of those in need of the services. WIDER IMPLICATIONS The World Health Organization is in a unique position to provide much needed guidance for infertility management in LMIC. This review provides insight into the landscape of ART in LMIC in various regions worldwide, which will guide efforts to improve the availability, quality, accessibility and acceptability of biomedical infertility care, including ART in these countries.
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Affiliation(s)
- Tendai M Chiware
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont Medical Center, Burlington, VT, USA
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Nathalie Vermeulen
- European Society of Human Reproduction and Embryology, Central Office, Grimbergen, Belgium
| | - Karel Blondeel
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Roy Farquharson
- European Society of Human Reproduction and Embryology, Central Office, Grimbergen, Belgium
| | - James Kiarie
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Kersti Lundin
- European Society of Human Reproduction and Embryology, Central Office, Grimbergen, Belgium
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thabo Christopher Matsaseng
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
- Reproductive Medicine Unit, Department of Obstetrics & Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Willem Ombelet
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt 3500, Belgium
- Genk Institute for Fertility Technology, ZOL Hospitals, Genk 3600, Belgium
| | - Igor Toskin
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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23
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Blondeel K, Dias S, Furegato M, Seuc A, Gama A, Fuertes R, Mendão L, Temmerman M, Toskin I. Sexual behaviour patterns and STI risk: results of a cluster analysis among men who have sex with men in Portugal. BMJ Open 2021; 11:e033290. [PMID: 33483434 PMCID: PMC7825267 DOI: 10.1136/bmjopen-2019-033290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Portugal has the highest HIV incidence rate in Western Europe. The proportion assigned to sexual contact between men recently increased to more than 30% of all HIV infections. Men who have sex with men (MSM) are vulnerable to the acquisition of other sexually transmitted infections (STIs), increasing the per-contact risk of HIV infection. Building on syndemic theory, the aim of this analysis was to identify patterns of current sexual behaviour in MSM, and explore their relationship with self-reported current, past STI diagnoses and HIV positive serostatus. DESIGN A cross-sectional behavioural survey was conducted in Portugal among MSM, using a community-based participatory research approach. Hierarchical cluster analysis was used to identify patterns including behavioural and demographic factors. RESULTS The analysis resulted in six clusters. Three clusters showed higher rates of current STI diagnosis (ranging from 11.7% to 17.1%), past STI diagnosis (ranging from 25.5% to 41.5%) and HIV positive serostatus (ranging from 13.0% to 16.7%). From the three clusters scoring lower on current and past STI and HIV diagnoses, one was characterised by a high number of sexual partners (62% had more than 12 partners in the last year), a high proportion (94.6%) of frequent visits to gay venues to meet sexual partners and high alcohol use (46.1%). The other two clusters scored lower on high risk sexual behaviour. CONCLUSION Factors other than sexual behaviour appear to reinforce the vulnerability to STIs and HIV of some MSM in this study, suggesting a syndemic of STIs, HIV and other adverse conditions. More research is needed to better understand the drivers of the STI/HIV epidemic in Portuguese MSM, using a concept that goes beyond risk behaviour, to develop effective combination prevention interventions.
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Affiliation(s)
- Karel Blondeel
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Sonia Dias
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
- National School of Public Health, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Martina Furegato
- Applied Diagnostic Research and Evaluation Unit (ADREU), University of London, St George's Molecular and Clinical Sciences Research Institute, London, UK
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, London, UK
| | - Armando Seuc
- Instituto Nacional de Higiene Epidemiología y Microbiología, Habana, Cuba
| | - Ana Gama
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | - Luís Mendão
- Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - Marleen Temmerman
- Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Igor Toskin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland
- Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moskva, Russian Federation
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Cordioli M, Gios L, Huber JW, Sherriff N, Folch C, Alexiev I, Dias S, Nöstlinger C, Gama A, Naseva E, Valkovičová Staneková D, Marcus U, Schink SB, Rosinska M, Blondeel K, Toskin I, Mirandola M. Estimating the percentage of European MSM eligible for PrEP: insights from a bio-behavioural survey in thirteen cities. Sex Transm Infect 2021; 97:534-540. [PMID: 33441447 DOI: 10.1136/sextrans-2020-054786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/31/2020] [Accepted: 11/08/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This paper aims to estimate the percentage of European men who have sex with men (MSM) who may benefit from pre-exposure prophylaxis (PrEP), applying the three most widely used HIV risk indices for MSM (MSM Risk Index, Menza score, San Diego Early Test (SDET) score) and drawing on a large-scale multisite bio-behavioural survey (Sialon II). METHODS The Sialon II study was a bio-behavioural survey among MSM implemented in 13 European cities using either time-location sampling or respondent-driven sampling. Biological and behavioural data from 4901 MSM were collected. Only behavioural data of HIV-negative individuals were considered. Three widely used risk indices to assess HIV acquisition risk among MSM were used to estimate individual HIV risk scores and PrEP eligibility criteria. RESULTS 4219 HIV-negative MSM were considered. Regardless the HIV risk score used and the city, percentages of MSM eligible for PrEP were found to range between 5.19% and 73.84%. Overall, the MSM Risk Index and the Menza score yielded broadly similar percentages, whereas the SDET Index provided estimates constantly lower across all cities. Although all the three scores correlated positively (r>0.6), their concordance was highly variable (0.01<CCC<0.62). CONCLUSION Our findings showed the impact of different scoring systems on the estimation of the percentage of MSM who may benefit from PrEP in European cities. Although our primary aim was not to compare the performance of different HIV risk scores, data show that a considerable percentage of MSM in each city should be offered PrEP in order to reduce HIV infections. As PrEP is highly effective at preventing HIV among MSM, our findings provide useful, practical guidance for stakeholders in implementing PrEP at city level to tackle HIV infections in Europe.
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Affiliation(s)
- Maddalena Cordioli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Lorenzo Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Jörg W Huber
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Nigel Sherriff
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Cinta Folch
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Catalonia Public Health Agency (ASPCAT), Badalona, Spain - Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ivailo Alexiev
- National Reference Confirmatory Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisboa, Lisboa, Portugal
| | | | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisboa, Lisboa, Portugal
| | - Emilia Naseva
- Ministry of Health, Program "Prevention and control of HIV/AIDS", Sofia, Bulgaria
| | | | - Ulrich Marcus
- Department of Infectious Diseases Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Magdalena Rosinska
- Department of Infectious Disease Epidemiology and Surveillance, National Institute of Public Health-National Institute of Hygiene, Warszawa, Poland
| | - Karel Blondeel
- Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium.,UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Igor Toskin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.,School of Health Sciences, University of Brighton, Brighton, UK
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25
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Keiding N, Ali MM, Eriksson F, Matsaseng T, Toskin I, Kiarie J. The Use of Time to Pregnancy for Estimating and Monitoring Human Fecundity From Demographic and Health Surveys. Epidemiology 2021; 32:27-35. [PMID: 33259462 PMCID: PMC7707157 DOI: 10.1097/ede.0000000000001296] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 09/24/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Available studies on the prevalence of infertility have proved to have certain limitations, with a scarcity of population-based studies and inconsistent reporting from surveys in countries at all income levels. We wanted to test the applicability of the current duration approach to data from the important Demographic and Health Surveys (DHS) program, funded by USAID since its inception in 1985, https://dhsprogram.com/. METHODS The current duration approach assumes that there is a well-defined time of initiation of attempts to get pregnant and defines the current duration of a still ongoing pregnancy attempt as the time interval from initiation to interview. The DHS interviews do not have an explicit question about initiation. We focused on nullipari and substituted date of "establishment of relationship with current partner" for initiation. Our study used the current duration approach on 15 datasets from DHS during 2002-2016 in eight different countries from sub-Saharan Africa, Asia, and Latin America. RESULTS Well-established statistical techniques for current duration data yielded results that for some countries postulated surprisingly long median times to pregnancy and surprisingly high estimates of infertility prevalence. Further study of the data structures revealed serious deviations from expected patterns, in contrast to our earlier experience from surveys in France and the United States where participants were asked explicitly about time of initiation of attempts to become pregnant. CONCLUSIONS Using cohabitation as a proxy for the initiation of attempts to get pregnant is too crude. Using the current duration approach with DHS data will require more explicit questions during the DHS interviews about initiation of pregnancy attempt.
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Affiliation(s)
- Niels Keiding
- From the Section of Biostatistics, Department of Public Health, Faculty of Health Sciences, University of Copenhagen. Copenhagen K, Denmark
| | - Mohamed M. Ali
- Department of Sexual and Reproductive Health and Research (SRH), World Health Organization, Geneva, Switzerland
| | - Frank Eriksson
- From the Section of Biostatistics, Department of Public Health, Faculty of Health Sciences, University of Copenhagen. Copenhagen K, Denmark
| | - Thabo Matsaseng
- Reproductive Medicine Unit, Stellenbosch University/Tygerberg Academic Hospital, Cape Town, South Africa
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research (SRH), World Health Organization, Geneva, Switzerland
| | - James Kiarie
- Department of Sexual and Reproductive Health and Research (SRH), World Health Organization, Geneva, Switzerland
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26
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Chemaitelly H, Majed A, Abu-Hijleh F, Blondeel K, Matsaseng TC, Kiarie J, Toskin I, Abu-Raddad LJ. Global epidemiology of Neisseria gonorrhoeae in infertile populations: systematic review, meta-analysis and metaregression. Sex Transm Infect 2020; 97:157-169. [PMID: 32423944 PMCID: PMC7892374 DOI: 10.1136/sextrans-2020-054515] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/14/2020] [Indexed: 01/04/2023] Open
Abstract
Objective To provide an in-depth systematic assessment of the global epidemiology of gonorrhoea infection in infertile populations. Methods A systematic literature review was conducted up to 29 April 2019 on international databases and WHO regional databases, and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All prevalence measures of gonorrhoea infection among infertile populations, based on primary data, qualified for inclusion. Infertile populations were broadly defined to encompass women/men undergoing infertility evaluation or treatment (infertility clinic attendees and partners). Pooled mean prevalence by relevant strata was estimated using random-effects meta-analysis. Associations with prevalence and sources of heterogeneity were explored using metaregression. Risk of bias was assessed using four quality domains. Findings A total of 147 gonorrhoea prevalence studies were identified from 56 countries. The pooled mean prevalence of current gonorrhoea infection was estimated globally at 2.2% (95% CI 1.3% to 3.2%), with the highest prevalence in Africa at 5.0% (95% CI 1.9% to 9.3%). The mean prevalence was higher for populations with tubal factor infertility (3.6%, 95% CI 0.9%–7.7%) and mixed cause and unexplained infertility (3.6%, 95% CI 0.0% to 11.6%) compared with other diagnoses, such as ovarian and non-tubal infertility (0.1%, 95% CI 0.0% to 0.8%), and for secondary (2.5%, 95% CI 0.2% to 6.5%) compared with primary (0.5%, 95% CI 0.0% to 1.7%) infertility. Metaregression identified evidence of variations in prevalence by region and by infertility diagnosis, higher prevalence in women than men and a small-study effect. There was a trend of declining prevalence by about 3% per year over the last four decades (OR=0.97, 95% CI 0.95 to 0.99). Conclusions Gonorrhoea prevalence in infertile populations is several folds higher than that in the general population, with even higher prevalence in women with tubal factor infertility and in individuals with secondary infertility. These findings support the potential role of gonorrhoea in infertility and suggest that some infertility is possibly preventable by controlling gonorrhoea transmission. PROSPERO registration number CRD42018102934.
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Affiliation(s)
- Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
| | - Alzahraa Majed
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
| | - Farah Abu-Hijleh
- Department of Public Health, College of Health Sciences, Academic Quality Affairs Office, QU Health, Qatar University, Doha, Qatar
| | - Karel Blondeel
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Thabo Christopher Matsaseng
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Department of Obstetrics & Gynaecology, Stellenbosch University, Stellenbosch, South Africa
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar .,Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA
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27
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Toskin I, Bakunina N, Gerbase AC, Blondeel K, Stephenson R, Baggaley R, Mirandola M, Aral SO, Laga M, Holmes KK, Winkelmann C, Kiarie JN. A combination approach of behavioural and biomedical interventions for prevention of sexually transmitted infections. Bull World Health Organ 2020; 98:431-434. [PMID: 32514218 PMCID: PMC7265927 DOI: 10.2471/blt.19.238170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Igor Toskin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Nataliia Bakunina
- Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Antonio Carlos Gerbase
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Karel Blondeel
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Rob Stephenson
- Department of Systems, Population and Leadership, University of Michigan, Ann Arbor, United States of America (USA)
| | - Rachel Baggaley
- HIV Department and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Marie Laga
- Institute of Tropical Medicine, Antwerp, Belgium
| | - King Kennard Holmes
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - James Njogu Kiarie
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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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: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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29
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Stephenson R, Metheny N, Goldenberg T, Bakunina N, De Vasconcelos S, Blondeel K, Kiarie J, Toskin I. Brief Intervention to Prevent Sexually Transmitted Infections and Unintended Pregnancies: Protocol of a Mixed Methods Feasibility Study. JMIR Res Protoc 2020; 9:e15569. [PMID: 32154787 PMCID: PMC7093772 DOI: 10.2196/15569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/10/2019] [Accepted: 11/19/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sexual well-being is fundamental to physical and emotional health, and the ability to achieve it depends on access to comprehensive sexuality information and high-quality sexual health care from evidence-informed, nonjudgmental providers. Adequate and timely delivery of these components to individuals who are at high risk for sexually transmitted infections (STIs), including HIV, and unintended pregnancies promotes sexual health and mitigates consequences arising from risky sexual behavior. Brief interventions that allow health care providers to improve the information available to clients and motivate and help them to develop risk-reduction skills are seen as efficient ways to improve knowledge, change client behavior, and reduce provider stigma regarding sexual health. OBJECTIVE The aim of the study is to evaluate five aspects of feasibility (acceptability, willingness, safety, satisfaction, and process) of a brief sexuality-related communication (BSC) intervention based on motivational interviewing and behavior change techniques in primary health care settings in low- and middle-income countries (LMICs). METHODS This protocol outlines a multisite, multiphase study of feasibility of a BSC intervention in primary health care settings in LMICs that will be examined across four phases of the study. Phases I through III involve the collection of formative, qualitative data to examine provider and client perceptions of the feasibility of the intervention, adaptation of the intervention guide, and training providers on how to implement the final version of the BSC intervention. During phase IV, the feasibility of the intervention will be tested in a nonrandomized pre-post test trial where providers and clients will be followed for 6 months and participate in multiphase data collection. RESULTS Phase I is currently underway in Moldova, and phases I and II were completed in Peru in late 2019. Results are expected for the feasibility study in 2021. CONCLUSIONS This feasibility study will determine whether the implementation of brief intervention programs aimed at improving sexual health outcomes is possible in the constraints of LMIC health systems and will add to our understanding of factors shaping clinical practice among primary care providers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15569.
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Affiliation(s)
- Rob Stephenson
- School of Nursing, University of Michigan, Ann Arbor, MI, United States.,Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Nicholas Metheny
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Tamar Goldenberg
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Nataliia Bakunina
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.,Higher School of Health Administration, Institute of Leadership and Health Care Management, First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Sofia De Vasconcelos
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Karel Blondeel
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - James Kiarie
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Igor Toskin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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30
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Mirandola M, Gios L, Sherriff N, Marcus U, Toskin I, Rosinska M, Schink S, Kühlmann-Berenzon S, Suligoi B, Folch C, Nöstlinger C, Dias S, Stanekova D, Klavs I, Caplinskas S, Rafila A, Marin C, Alexiev I, Zohrabyan L, Noori T, Menel-Lemos C, On Behalf Of The Sialon Ii Network. Quantifying unmet prevention needs among MSM in Europe through a multi-site bio-behavioural survey. ACTA ACUST UNITED AC 2019; 23. [PMID: 30621823 PMCID: PMC6290532 DOI: 10.2807/1560-7917.es.2018.23.49.1800097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Introduction The HIV epidemic represents an important public health issue in Europe particularly among men who have sex with men (MSM). Global AIDS Monitoring indicators (GAM) have been widely and jointly promoted as a set of crucial standardised items to be adopted for monitoring and responding to the epidemic. Methods The Sialon II study, implemented in 13 European cities (2013-14), was a complex multi-centre integrated bio-behavioural cross-sectional survey targeted at MSM, with a concomitant collection of behavioural and biological (oral fluid or blood specimens) data. Rigorous sampling approaches for hard-to-reach populations were used (time-location sampling and respondent-driven sampling) and GAM indicators were calculated; sampling frames were adapted to allow weighted estimates of GAM indicators. Results 4,901 MSM were enrolled. HIV prevalence estimates ranged from 2.4% in Stockholm to 18.0% in Bucharest. When exploring city-level correlations between GAM indicators, prevention campaigns significantly correlated with levels of condom use and level of HIV testing among MSM. Conclusion The Sialon II project has made an important contribution to the monitoring and evaluation of the HIV epidemic across Europe, integrating the use of GAM indicators within a second generation HIV surveillance systems approach and in participatory collaboration with MSM communities. It influenced the harmonisation of European data collection procedures and indicators via GAM country reporting and contributed essential knowledge informing the development and implementation of strategic, evidence-based HIV prevention campaigns for MSM.
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Affiliation(s)
- Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Lorenzo Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Nigel Sherriff
- School of Health Sciences, University of Brighton, Brighton, United Kingdom
| | - Ulrich Marcus
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Magdalena Rosinska
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Susanne Schink
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Sharon Kühlmann-Berenzon
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
| | - Barbara Suligoi
- Centro Operativo AIDS, Dipartimento di Malattie Infettive, Parassitarie ed Immunomediate, Istituto Superiore di Sanità, Rome, Italy
| | - Cinta Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya / CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - Christiane Nöstlinger
- Faculty of Psychology, University of Vienna, Austria.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sonia Dias
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública & GHTM, Universidade NOVA de Lisboa, Portugal
| | - Danica Stanekova
- NRC for HIV/AIDS, Slovak Medical University, Bratislava, Slovak Republic
| | - Irena Klavs
- National Institute of Public Health, Ljubljana, Slovenia
| | - Saulius Caplinskas
- Centre for Communicable Diseases and AIDS, Mykolas Romeris University, Vilnius, Lithuania
| | - Alexandru Rafila
- National Institute of Infectious Diseases Prof. Dr. Matei Bals, Bucharest, Romania
| | | | - Ivailo Alexiev
- National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Lev Zohrabyan
- Regional Support Team Joint United Nations Programme on HIV/AIDS (UNAIDS), Moscow, Russia
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Cinthia Menel-Lemos
- Consumers, Health, Agriculture and Food Executive Agency (Chafea), Luxembourg
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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: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Chemaitelly H, Harfouche M, Blondeel K, Matsaseng TC, Kiarie J, Toskin I, Abu-Raddad LJ. Global epidemiology of Neisseria gonorrhoeae in infertile populations: protocol for a systematic review. BMJ Open 2019; 9:e025808. [PMID: 31122971 PMCID: PMC6538097 DOI: 10.1136/bmjopen-2018-025808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION A key target of the WHO's 'Global Health Sector Strategy on sexually transmitted infections, 2016-2021' is achieving 90% reduction in Neisseria gonorrhoeae (gonorrhoea for short) incidence globally by 2030. Though untreated, gonorrhoea has been linked to infertility, the epidemiology of this infection in infertile populations remains poorly understood and somewhat a neglected area of reproductive health. Our proposed systematic review aims to fill this gap by characterising comprehensively gonorrhoea infection in infertile populations globally. METHODS AND ANALYSIS All available studies of gonorrhoea infection in infertile populations, including infertility clinic attendees, will be systematically reviewed informed by Cochrane Collaboration guidelines. Findings will be reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources will be searched using broad index terms exploded to cover all subheadings and free text terms with no language or year restriction. Any epidemiological measure in infertile populations based on primary data will be eligible for inclusion. Measures based on different assay types will be extracted as separate studies for different analyses. Only one biospecimen type per assay type will be considered based on a predefined priority order. Samples including fewer than 10 participants or assessing infection in the upper genital tract will be excluded. Quality assessments will be conducted for all measures included in the review. Meta-analyses will be implemented using DerSimonian-Laird random effect models to estimate the mean prevalence of gonorrhoea in infertile populations globally, and stratified by WHO region, assay type, sex, infertility type, infertility diagnosis, among other factors. Detailed heterogeneity assessment will be performed, and potential sources of between-study heterogeneity will be explored using meta-regression. Review will be conducted from 26 March 2018 to 28 July 2019. ETHICS AND DISSEMINATION An institutional review board clearance is not required as all data are publicly available. The findings will be disseminated through a peer-reviewed publication and international scientific meetings/workshops with key stakeholders. PROSPERO REGISTRATION NUMBER CRD42018102934.
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Affiliation(s)
- Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Manale Harfouche
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Karel Blondeel
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York City, New York, USA
- College of Health and Life Sciences, Hamadbin Khalifa University, Doha, Qatar
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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: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Jacobsson S, Boiko I, Golparian D, Blondeel K, Kiarie J, Toskin I, Peeling RW, Unemo M. WHO laboratory validation of Xpert ® CT/NG and Xpert ® TV on the GeneXpert system verifies high performances. APMIS 2018; 126:907-912. [PMID: 30456870 PMCID: PMC6488022 DOI: 10.1111/apm.12902] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/09/2018] [Indexed: 11/30/2022]
Abstract
Effective tests for diagnosis of sexually transmitted infections (STIs), used point of care to inform treatment and management decisions, are urgently needed. We evaluated the analytical sensitivity and specificity of the Xpert® CT/NG and Xpert® TV tests, examining 339 samples spiked with phenotypically and/or genetically diverse strains of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis, and other related species that may cross-react. The APTIMA Combo 2 test and APTIMA TV test were used as reference tests. The analytical sensitivity for all three agents in the Xpert® CT/NG and Xpert® TV tests was ≤102 genome equivalents/reaction. The analytical specificity of both tests was high. False-positive results were identified in the Xpert® TV test when challenging with high concentrations of Trichomonas tenax, Trichomonas gallinae, Trichomonas stableri, and Trichomonas aotus. However, the clinical relevance of these cross-reactions can likely be neglected, because these species have not been identified in urogenital samples from humans. In conclusion, the analytical sensitivity and specificity of the user-friendly Xpert® CT/NG and Xpert® TV tests on the GeneXpert system were high. The results support the use of specimens from also extra-genital sites, for example, pharynx and rectum. However, appropriate clinical validations are additionally required.
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Affiliation(s)
- Susanne Jacobsson
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, National Reference Laboratory for Sexually Transmitted Infections, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Iryna Boiko
- Clinical Laboratory Department, Ternopil Regional Clinical Dermatovenerologic Dispensary, Ternopil, Ukraine
| | - Daniel Golparian
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, National Reference Laboratory for Sexually Transmitted Infections, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karel Blondeel
- Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
| | | | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, National Reference Laboratory for Sexually Transmitted Infections, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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De Vasconcelos S, Toskin I, Cooper B, Chollier M, Stephenson R, Blondeel K, Troussier T, Kiarie J. Behaviour change techniques in brief interventions to prevent HIV, STI and unintended pregnancies: A systematic review. PLoS One 2018; 13:e0204088. [PMID: 30260991 PMCID: PMC6159869 DOI: 10.1371/journal.pone.0204088] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 09/04/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Behaviour-change interventions have been consistently considered an essential part of comprehensive HIV, STI and unintended pregnancy prevention. In 2015, the World Health Organization reviewed and assessed existing evidence on brief behavioural interventions, leading to the publication of Brief sexuality-related communication: recommendations for a public health approach. This guideline recommends the use of brief behaviour intervention and communication programmes to promote sexual health and to prevent HIV, STIs, and unintended pregnancies in primary health services, particularly sexual and reproductive health services. OBJECTIVE With the purpose of informing the development of a brief behaviour intervention in sexual and reproductive health, we conducted a systematic review of brief intervention to prevent HIV, STI and unintended pregnancies, to identify behaviour change techniques (BCTs) used in health care settings. METHODS Participants from all ages and genders were included. Brief interventions delivered in ≤ 60 minutes were included. Data was extracted, and interventions were coded following the Behaviour Change Techniques Taxonomy (BCTTv1) guidelines. RESULTS Of the 6.687 articles identified, 355 were reviewed and 37 studies were included. In effective interventions, we identified 48 behaviour change techniques (BCTs). A core set of 8 frequently used behaviour change techniques was identified: "Problem solving", "Feedback on behaviour", "Social support (unspecified)", "Instructions on how to perform the behaviour", "Information about health consequences", "Information about social and environmental consequences", "Demonstration of the behaviour" and "Credible source". CONCLUSIONS The technical content of brief behaviour interventions was identified in a reliable and standardized way providing preliminary indications on potentially effective techniques to achieve behaviour change.
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Affiliation(s)
- Sofia De Vasconcelos
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Bergen Cooper
- Center for Health and Gender Equity (CHANGE), Washington, D.C., United States of America
| | - Marie Chollier
- UNESCO Chair for Sexual Health and Human Rights (UCSHHR), Paris, France
- Manchester Metropolitan University, Manchester, United Kingdom
| | - Rob Stephenson
- School of Nursing and the Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Karel Blondeel
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Thierry Troussier
- UNESCO Chair for Sexual Health and Human Rights (UCSHHR), Paris, France
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Marcus U, Nöstlinger C, Rosińska M, Sherriff N, Gios L, Dias SF, Gama AF, Toskin I, Alexiev I, Naseva E, Schink SB, Mirandola M. Behavioural and demographic correlates of undiagnosed HIV infection in a MSM sample recruited in 13 European cities. BMC Infect Dis 2018; 18:368. [PMID: 30081839 PMCID: PMC6080551 DOI: 10.1186/s12879-018-3249-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/10/2018] [Indexed: 12/29/2022] Open
Abstract
Background Reducing the number of people with undiagnosed HIV infection is a major goal of HIV control and prevention efforts in Europe and elsewhere. We analysed data from a large multi-city European bio-behavioural survey conducted among Men who have Sex with Men (MSM) for previously undiagnosed HIV infections, and aimed to characterise undiagnosed MSM who test less frequently than recommended. Methods Data on sexual behaviours and social characteristics of MSM with undiagnosed HIV infection from Sialon II, a bio-behavioural cross-sectional survey conducted in 13 European cities in 2013/2014, were compared with HIV-negative MSM. Based on reported HIV-testing patterns, we distinguished two subgroups: MSM with a negative HIV test result within 12 months prior to the study, i.e. undiagnosed incident infection, and HIV positive MSM with unknown onset of infection. Bivariate and multivariate associations of explanatory variables were analysed. Distinct multivariate multi-level random-intercept models were estimated for the entire group and both subgroups. Results Among 497 participants with HIV-reactive specimens, 234 (47.1%) were classified as previously diagnosed, 106 (21.3%) as incident, and 58 (11.7%) as unknown onset based on self-reported status and testing history. MSM with incident HIV infection were twice as likely (odds ratio (OR) = 2.22, 95% confidence interval (95%CI): 1.17–4.21) to have used recreational substances during their last anal sex encounter and four times more likely (OR = 3.94, 95%CI: 2.14–7.27) not to discuss their HIV status with the last anal sex partner(s). MSM with unknown onset of HIV infection were 3.6 times more likely (OR = 3.61, 95%CI: 1.74–7.50) to report testing for a sexually transmitted infection (STI) during the last 12 months. Conclusions Approximately one third of the study participants who are living with HIV were unaware of their infection. Almost two-third (65%) of those with undiagnosed HIV appeared to have acquired the infection recently, emphasizing a need for more frequent testing. Men with the identified behavioural characteristics could be considered as primary target group for HIV Pre-Exposure Prophylaxis (PrEP) to avoid HIV infection. The increased odds of those with unknown onset of HIV infection to have had an STI test in the past year strongly suggests a lost opportunity to offer HIV testing. Electronic supplementary material The online version of this article (10.1186/s12879-018-3249-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulrich Marcus
- Department of Infectious Diseases Epidemiology, Robert Koch-Institute, Berlin, Germany.
| | | | - Magdalena Rosińska
- Department of Epidemiology, National Institute of Public Health, Warsaw, Poland
| | | | - Lorenzo Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Sonia F Dias
- Escola Nacional de Saúde Pública Universidade, Centro de Investigação em Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana F Gama
- Instituto de Higiene e Medicina Tropical, Global Health and Tropical Medicine, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ivailo Alexiev
- National Centre of Infectious and Parasitic Diseases, National Reference Laboratory of HIV, Sofia, Bulgaria
| | - Emilia Naseva
- Ministry of Health, Program "Prevention and control of HIV/AIDS", Sofia, Bulgaria
| | | | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Madyanova V, Halfin R, Toskin I, Shkarin V, Kobyatskaya E, Polushkin V. 2.10-P5Right for healthcare for migrants, refugees and stateless persons in Russia. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- V Madyanova
- Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - R Halfin
- Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - I Toskin
- Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - V Shkarin
- Ministry of Health of Volgograd Region, Volgograd, Russian Federation
- Volgograd State Medical Univercity, Volgograd, Russian Federation
| | - E Kobyatskaya
- Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - V Polushkin
- Sechenov First Moscow State Medical University, Moscow, Russian Federation
- Medsi Clinical Hospital #1, Moscow, Russian Federation
- City Clinical Hospital #17, Moscow, Russian Federation
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Madyanova V, Halfin R, Toskin I, Shkarin V, Manshina A, Polushkin V. 3.11-P16Health monitoring and reporting for migrants, refugees and stateless individuals in Russia: mechanisms, scope, and development perspectives. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Madyanova
- Institute o Leadership in Healthcare, Sechenov First Moscow State Medical University, Russian Federation
| | - R Halfin
- Institute o Leadership in Healthcare, Sechenov First Moscow State Medical University, Russian Federation
| | - I Toskin
- Institute o Leadership in Healthcare, Sechenov First Moscow State Medical University, Russian Federation
| | - V Shkarin
- Ministry of Health of Volgograd Region, Russian Federation
- Volgograd State Medical Univercity, Russian Federation
| | - A Manshina
- National Research Center for Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Russian Federation
| | - V Polushkin
- Institute o Leadership in Healthcare, Sechenov First Moscow State Medical University, Russian Federation
- Clinical hospital Medsi #1, Russian Federation
- City Clinical Hospital #17, Russian Federation
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Toskin I, Peeling RW, Mabey D, Holmes K, Ballard R, Kiarie J, Askew I. Point-of-care tests for STIs: the way forward. Sex Transm Infect 2018; 93:S1-S2. [PMID: 29223958 DOI: 10.1136/sextrans-2016-053074] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/21/2017] [Accepted: 07/02/2017] [Indexed: 11/03/2022] Open
Affiliation(s)
- Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - David Mabey
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - King Holmes
- Department of Global Health & Medicine, University of Washington, Seattle, Washington, USA
| | - Ronald Ballard
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ian Askew
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Toskin I, Blondeel K, Peeling RW, Deal C, Kiarie J. Advancing point of care diagnostics for the control and prevention of STIs: the way forward. Sex Transm Infect 2018; 93:S81-S88. [PMID: 29223966 DOI: 10.1136/sextrans-2016-053073] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/06/2017] [Accepted: 06/23/2017] [Indexed: 01/01/2023] Open
Abstract
WHO recognises the global impact of sexually transmitted infections (STIs) on global public health and individual sexual and reproductive health and well-being. As a component of the WHO Global Health Sector Strategy for the control and prevention of STIs, there has been a growing recognition of the importance of integrating point-of-care tests (POCTs) into overall strategic planning. The process of integrating STI POCTs, in addition to providing a definitive diagnosis and appropriate treatment in a single visit, also includes innovative delivery options, such as on-site delivery, community-based testing (including screening), as well as self-testing at home after purchase of a test online or over-the-counter. WHO organised two technical consultations in May 2014 and July 2015. This article summarises the discussions of the meeting participants on advancing the use of POCTs to control and prevent STIs. The following priorities were identified: the need for pathogens' target discovery; encouragement of multiplexing, miniaturisation, simplification and connectivity; promotion of standardisation of evaluation of new diagnostic platforms across all stages of the evaluation pipeline; the need for an investment case, modelling and scenarios to ensure buy-in among key stakeholders, including developers and the private sector; the need for norms and standards, including guidelines, to support introduction of STI POCTs in programmes; anticipating potential tensions between different parties at the implementation level; and leveraging on the global initiative, Sustainable Development Goals (SDGs)/global health sector STI strategy, to sustain investment in STI POCT programmes. There is a rich pipeline of diagnostic products, but some have stalled in development. An approach to accelerate the evaluation of new diagnostics is to set up a competent network of evaluation sites ahead of time, harmonise regulatory approval processes with development of models to estimate cost-effectiveness, informed by better STI data. This should result in accelerating policy development. Although it may be some time before good POCTs can be widely implemented in low resource settings, it is important to be a catalyst for continued development and use of these essential tools as an integral part of both the WHO Global Health Sector Strategy and the agenda for 2030.
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Affiliation(s)
- Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Karel Blondeel
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Carolyn Deal
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Rockville, USA
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Zorzi A, Cordioli M, Gios L, Del Bravo P, Toskin I, Peeling RW, Blondeel K, Cornaglia G, Kiarie J, Ballard R, Mirandola M. Field evaluation of two point-of-care tests for syphilis among men who have sex with men, Verona, Italy. Sex Transm Infect 2018; 93:S51-S58. [PMID: 29223963 DOI: 10.1136/sextrans-2016-053065] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/30/2017] [Accepted: 06/10/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The incidence of HIV and syphilis among men who have sex with men (MSM) in Europe has recently increased. Rapid point-of-care tests (POCTs) for syphilis can improve access to screening. The purpose of this study was to evaluate the performance of two syphilis POCTs compared with laboratory tests among MSM. METHODS The study was undertaken in Verona, Italy. Asymptomatic MSM, potentially exposed to syphilis, were enrolled prospectively. The POCTs evaluated were SD Bioline Syphilis 3.0 and Chembio DPP Syphilis Screen & Confirm Assay on both serum and fingerprick blood. The results of the POCTs were read by the naked eye by two independent readers and their concordance assessed. RESULTS A total of 289 MSM were enrolled in the study. Based on laboratory tests, 35 MSM (12.1%) were TPPA-positive alone and 16 (5.5%) were both Treponema pallidum particle agglutination test (TPPA) and rapid plasma reagin (RPR)-positive. The specificities of both POCTs were above 99% on both serum and fingerstick blood specimens, while sensitivities varied considerably. The sensitivity of the SD Bioline test was lower on fingerprick blood (51.4% and 54.3%, readers 1 and 2, respectively) compared with that on serum (80.0% and 82.9%). In contrast, the Chembio test exhibited similar sensitivity values for serum and fingerprick samples (57.7% and 64.0% on serum vs 65.4% and 69.2% on fingerprick for the treponemal component; 63.6% on both samples by both readers for the non-treponemal component). The positive predictive value ranged between 100% and 93.9% for the treponemal component of both syphilis POCTs, but was lower (76.3%-100%)%) for the non-treponemal component of the Chembio POCT. The negative predictive value surpassed 90% for both tests on both samples. The agreement between readers was very high (>99%). CONCLUSION The diagnostic performance of the syphilis POCTs was lower than expected; however, considering the prevalence of syphilis among MSM, POCTs should be recommended to improve syphilis detection among MSM.
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Affiliation(s)
- Antonella Zorzi
- Virology and Microbiology Unit, Department of Pathology and Diagnostics, Verona University Hospital, Verona, Italy
| | - Maddalena Cordioli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Lorenzo Gios
- Regional Coordination Centre for European Project Management, Verona University Hospital, Verona, Italy
| | - Paola Del Bravo
- Infectious Diseases and Tropical Medicine Unit, Department of General Medicine, Verona University Hospital, Verona, Italy
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rosanna W Peeling
- International Diagnostics Centre, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Karel Blondeel
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Giuseppe Cornaglia
- Virology and Microbiology Unit, Department of Pathology and Diagnostics, Verona University Hospital, Verona, Italy
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ronald Ballard
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.,Regional Coordination Centre for European Project Management, Verona University Hospital, Verona, Italy
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Guy RJ, Causer LM, Klausner JD, Unemo M, Toskin I, Azzini AM, Peeling RW. Performance and operational characteristics of point-of-care tests for the diagnosis of urogenital gonococcal infections. Sex Transm Infect 2018; 93:S16-S21. [PMID: 29223959 DOI: 10.1136/sextrans-2017-053192] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/30/2017] [Accepted: 08/08/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In 2012, there was an estimated 78 million new cases of gonorrhoea globally. Untreated infection may lead to reproductive and neonatal morbidity and facilitate HIV transmission. Diagnosis and treatment are a priority for control and prevention, yet use of point-of-care tests (POCTs) for Neisseria gonorrhoeae (NG) is limited. OBJECTIVES To review the performance and operational characteristics of NG POCTs for diagnosis of urogenital gonorrhoea. METHODS We compiled and synthesised findings from two separate systematic reviews which included evaluations published until August 2015. RESULTS Six tests were included: five were immunochromatographic tests (ICTs) or optical immunoassay (OIAs) based on antigen detection; with 5-7 steps and results in 25-40 min, and one (GeneXpert CT/NG) was a 'near-patient test' based on nucleic acid amplification technique (NAAT); with three steps, electricity required, and results in 90 min. When compared with laboratory-based NAATs as the reference tests, sensitivities of ICT and OIA-based POCTs ranged from 12.5% to 70% when cervical/vaginal swabs were tested. Specificities ranged from 89% to 99.8%. The near-patient NAAT had sensitivities of >95% and specificities of >99.8% consistently across all specimen types (urine, cervical and vaginal swabs). CONCLUSIONS Based on a limited number of evaluations, antigen detection POCTs for NG lacked sufficient sensitivity to be used for screening. A near-patient NAAT has acceptable performance, only involved a few steps, but needs electricity, a temperature-controlled environment and has a 90 min run time. To achieve wider scale up of NG POCTs, we need strong evidence of cost-effectiveness, which should inform guidelines and ultimately increase test development, demand and reduce costs.
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Affiliation(s)
- Rebecca J Guy
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Louise M Causer
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Jeffrey D Klausner
- Department of Global Health, University of California at Los Angeles, San Francisco, USA
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University Hospital, Örebro, Sweden
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Toskin I, Murtagh M, Peeling RW, Blondeel K, Cordero J, Kiarie J. Advancing prevention of sexually transmitted infections through point-of-care testing: target product profiles and landscape analysis. Sex Transm Infect 2018; 93:S69-S80. [PMID: 29223965 DOI: 10.1136/sextrans-2016-053071] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 10/16/2017] [Accepted: 10/27/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Advancing the field of point-of-care testing (POCT) for STIs can rapidly and substantially improve STI control and prevention by providing targeted, essential STI services (case detection and screening). POCT enables definitive diagnosis and appropriate treatment in a single visit and home and community-based testing. METHODS Since 2014, the WHO Department of Reproductive Health and Research, in collaboration with technical partners, has completed four landscape analyses of promising diagnostics for use at or near the point of patient care to detect syphilis, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and the human papillomavirus. The analyses comprised a literature review and interviews. Two International Technical Consultations on STI POCTs (2014 and 2015) resulted in the development of target product profiles (TPP). Experts in STI microbiology, laboratory diagnostics, clinical management, public health and epidemiology participated in the consultations with representation from all WHO regions. RESULTS The landscape analysis identified diagnostic tests that are either available on the market, to be released in the near future or in the pipeline. The TPPs specify 28 analytical and operational characteristics of POCTs for use in different populations for surveillance, screening and case management. None of the tests that were identified in the landscape analysis met all of the targets of the TPPs. CONCLUSION More efforts of the global health community are needed to accelerate access to affordable quality-assured STI POCTs, particularly in low- and middle-income countries, by supporting the development of new diagnostic platforms as well as strengthening the validation and implementation of existing diagnostics according to internationally endorsed standards and the best available evidence.
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Affiliation(s)
- Igor Toskin
- Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
| | - Maurine Murtagh
- The Murtagh Group, Limited Liability Company (LLC), Woodside, USA
| | | | - Karel Blondeel
- Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Joanna Cordero
- Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
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44
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Kelly H, Coltart CEM, Pant Pai N, Klausner JD, Unemo M, Toskin I, Peeling RW. Systematic reviews of point-of-care tests for the diagnosis of urogenital Chlamydia trachomatis infections. Sex Transm Infect 2018; 93:S22-S30. [PMID: 29223960 DOI: 10.1136/sextrans-2016-053067] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/29/2017] [Accepted: 06/03/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND WHO estimates that 131 million new cases of urogenital Chlamydia trachomatis (CT) infections occur globally every year. Most infections are asymptomatic. Untreated infection in women can lead to severe complications. Screening and treatment of at-risk populations is a priority for prevention and control. OBJECTIVES To summarise systematic reviews of the performance characteristics of commercially available point-of-care tests (POCT) for screening and diagnosis of urogenital CT infection. METHODS Two separate systematic reviews covering the periods 2004-2013 and 2010-2015 were conducted on rapid CT POCTs. Studies were included if tests were evaluated against a valid reference standard. RESULTS In the first review, 635 articles were identified, of which 11 were included. Nine studies evaluated the performance of eight antigen detection rapid POCTs on 10 280 patients and two studies evaluated a near-patient nucleic acid amplification test (NAAT) on 3518 patients. Pooled sensitivity of antigen detection tests was 53%, 37% and 63% for cervical swabs, vaginal swabs and male urine, and specificity was 99%, 97% and 98%, respectively. The pooled sensitivity and specificity of the near-patient NAAT for all specimen types were >98% and 99.4%, respectively. The second review identified two additional studies on four antigen detection POCTs with sensitivities and specificities of 22.7%-37.7% and 99.4%-100%, respectively. A new two-step 15 min rapid POCT using fluorescent nanoparticles showed performance comparable to that of near-patient NAATs. CONCLUSIONS The systematic reviews showed that antigen detection POCTs for CT, although easy to use, lacked sufficient sensitivity to be recommended as a screening test. A near-patient NAAT shows acceptable performance as a screening or diagnostic test but requires electricity, takes 90 min and is costly. More affordable POCTs are in development.
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Affiliation(s)
- Helen Kelly
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Cordelia E M Coltart
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Nitika Pant Pai
- Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Jeffrey D Klausner
- Department of Global Health, University of California, Los Angeles, California, USA
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University Hospital, Orebro, Sweden
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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45
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Folch C, Zohrabyan L, Vagaitseva N, Casabona J, Toskin I. Measurement of sexual health outcomes among people who inject drugs: pilot study in Catalonia, Spain and Barnaul, Russia. BMC Public Health 2018; 18:187. [PMID: 29378541 PMCID: PMC5789694 DOI: 10.1186/s12889-018-5065-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The main objective of this study was to test some of the draft sexual health indicators developed by the World Health Organization as part of a comprehensive indicator framework to monitor progress in universal access to reproductive health. METHODS Cross-sectional studies among people who inject drugs were conducted in Catalonia (n = 734) and Barnaul (n = 500). 'Sexual competency' was measured using three indicators: sexual satisfaction, sexual safety, and sexual autonomy. Individual social norms on sexuality were also collected. The construct validity of the sexual safety and sexual autonomy items were assessed. Multivariate logistic regression models explored factors associated with sexual dissatisfaction. RESULTS In Catalonia, sexual competency was higher among males than females who inject drugs (60.4% versus 33.3%). In both Catalonia and Barnaul, differences by sex in social norms on sexuality were seen. Mean scores on sexual safety (4.15 in Catalonia and 3.54 in Barnaul) were lower among participants who reported not using condoms. Mean scores on sexual autonomy (4.42 in Catalonia and 3.97 in Barnaul) were lower among those who had experienced some form of sexual assault. Perceived sexual safety, sexual autonomy, and social norms on sexuality were associated with sexual dissatisfaction. CONCLUSIONS The sexual health indicators tested are valid, feasible, and reliable tools to monitor and evaluate sexual health programs and activities. The results confirm that sexual satisfaction depends on safe sexual experiences, free from coercion and violence. Social norms and individual perceptions about sexual health need to be considered when developing national disease prevention programs.
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Affiliation(s)
- Cinta Folch
- Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain
- Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Lev Zohrabyan
- Joint United Nations Programme on HIV and AIDS (UNAIDS), Moscow, Russian Federation
| | | | - Jordi Casabona
- Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain
- Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Igor Toskin
- World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
| | - the local REDAN Group
- Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain
- Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
- Joint United Nations Programme on HIV and AIDS (UNAIDS), Moscow, Russian Federation
- Altai Regional AIDS center, Barnaul, Russia
- World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
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46
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Blondeel K, de Vasconcelos S, García-Moreno C, Stephenson R, Temmerman M, Toskin I. Violence motivated by perception of sexual orientation and gender identity: a systematic review. Bull World Health Organ 2018; 96:29-41L. [PMID: 29403098 PMCID: PMC5791869 DOI: 10.2471/blt.17.197251] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the prevalence of physical and sexual violence motivated by perception of sexual orientation and gender identity in sexual and gender minorities. METHODS We searched nine databases without language restrictions for peer-reviewed and grey literature published from 2000 to April 2016. We included studies with more than 50 participants that measured the prevalence of physical and sexual violence perceived as being motivated by sexual orientation and gender identity or gender expression. We excluded intimate partner violence and self-harm. Due to heterogeneity and the absence of confidence intervals in most studies, we made no meta-analysis. FINDINGS We included 76 articles from 50 countries. These covered 74 studies conducted between 1995 and 2014, including a total of 202 607 sexual and gender minority participants. The quality of data was relatively poor due to a lack of standardized measures and sometimes small and non-randomized samples. In studies where all sexual and gender minorities were analysed as one population, the prevalence of physical and sexual violence ranged from 6% (in a study including 240 people) to 25% (49/196 people) and 5.6% (28/504) to 11.4% (55/484), respectively. For transgender people the prevalence ranged from 11.8% (of a subsample of 34 people) to 68.2% (75/110) and 7.0% (in a study including 255 people) to 49.1% (54/110). CONCLUSION More data are needed on the prevalence, risk factors and consequences of physical and sexual violence motivated by sexual orientation and gender identity in different geographical and cultural settings. National violence prevention policies and interventions should include sexual and gender minorities.
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Affiliation(s)
- Karel Blondeel
- Faculty of Medicine and Health Sciences, Ghent University, Campus UZ Gent, Building K3, 3rd floor, De Pintelaan 185, 9000 Gent, Belgium
| | - Sofia de Vasconcelos
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Claudia García-Moreno
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, United States of America
| | - Marleen Temmerman
- Faculty of Medicine and Health Sciences, Ghent University, Campus UZ Gent, Building K3, 3rd floor, De Pintelaan 185, 9000 Gent, Belgium
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Marcus U, Schink SB, Sherriff N, Jones AM, Gios L, Folch C, Berglund T, Nöstlinger C, Niedźwiedzka-Stadnik M, Dias SF, Gama AF, Naseva E, Alexiev I, Staneková D, Toskin I, Pitigoi D, Rafila A, Klavs I, Mirandola M. HIV serostatus knowledge and serostatus disclosure with the most recent anal intercourse partner in a European MSM sample recruited in 13 cities: results from the Sialon-II study. BMC Infect Dis 2017; 17:730. [PMID: 29178847 PMCID: PMC5702243 DOI: 10.1186/s12879-017-2814-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022] Open
Abstract
Background Knowledge of HIV status can be important in reducing the risk of HIV exposure. In a European sample of men-who-have-sex-with-men (MSM), we aimed to identify factors associated with HIV serostatus disclosure to the most recent anal intercourse (AI) partner. We also aimed to describe the impact of HIV serostatus disclosure on HIV exposure risks. Methods During 2013 and 2014, 4901 participants were recruited for the bio-behavioural Sialon-II study in 13 European cities. Behavioural data were collected with a self-administered paper questionnaire. Biological specimens were tested for HIV antibodies. Factors associated with HIV serostatus disclosure with the most recent AI partner were examined using bivariate and multilevel multivariate logistic regression analysis. We also describe the role of serostatus disclosure for HIV exposure of the most recent AI partner. Results Thirty-five percent (n = 1450) of the study participants reported mutual serostatus disclosure with their most recent AI partner or disclosed having HIV to their partner. Most of these disclosures occurred between steady partners (74%, n = 1077). In addition to the type of partner and HIV diagnosis status, other factors positively associated with HIV serostatus disclosure in the multilevel multivariate logistic regression model were recent testing, no condom use, and outness regarding sexual orientation. Disclosure rates were lowest in three south-eastern European cities. Following condom use (51%, n = 2099), HIV serostatus disclosure (20%, n = 807) was the second most common prevention approach with the most recent AI partner, usually resulting in serosorting. A potential HIV exposure risk for the partner was reported by 26% (111/432) of HIV antibody positive study participants. In 18% (20/111) of exposure episodes, an incorrect HIV serostatus was unknowingly communicated. Partner exposures were equally distributed between steady and non-steady partners. Conclusions The probability of HIV exposure through condomless AI is substantially lower after serostatus disclosure compared to non-disclosure. Incorrect knowledge of one’s HIV status contributes to a large proportion of HIV exposures amongst European MSM. Maintaining or improving condom use for anal intercourse with non-steady partners, frequent testing to update HIV serostatus awareness, and increased serostatus disclosure particularly between steady partners are confirmed as key aspects for reducing HIV exposures amongst European MSM. Electronic supplementary material The online version of this article (10.1186/s12879-017-2814-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulrich Marcus
- Department of Infectious Diseases Epidemiology, Robert Koch-Institute, Berlin, Germany.
| | | | | | - Anna-Marie Jones
- University of Brighton, Health Sciences, Brighton, UK.,Mill View Hospital, Sussex Education Centre, Research & Development, Brighton, UK
| | - Lorenzo Gios
- Department of Health, Verona University Hospital, CReMPE - Regional Coordination Centre for European Project Management, Verona, Veneto Region, Italy
| | - Cinta Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Badalona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Torsten Berglund
- Department of Monitoring & Evaluation, Public Health Agency of Sweden, Solna, Sweden
| | | | | | - Sonia F Dias
- Universidade Nova de Lisboa, Instituto de Higiene e Medicina Tropical, Global Health and Tropical Medicine, Lisbon, Portugal
| | - Ana F Gama
- Universidade Nova de Lisboa, Instituto de Higiene e Medicina Tropical, Global Health and Tropical Medicine, Lisbon, Portugal
| | - Emilia Naseva
- Ministry of Health, Program "Prevention and Control of HIV/AIDS", Sofia, Bulgaria
| | - Ivailo Alexiev
- National Centre of Infectious and Parasitic Diseases, National Reference Laboratory of HIV, Sofia, Bulgaria
| | - Danica Staneková
- Slovak Medical University, National Reference Centre for HIV/AIDS, Bratislava, Slovakia
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Daniela Pitigoi
- University of Medicine and Pharmacy Carol Davila, Department Clinic 2, Epidemiology, Bucharest, Romania.,National Institute for Infectious Diseases "Prof Dr Matei Bals", Bucharest, Romania
| | - Alexandru Rafila
- Department of Microbiology, National Institute of Infectious Diseases "Prof Dr Matei Bals", Bucharest, Romania
| | - Irena Klavs
- National Institute of Public Health, Communicable Diseases Centre, Ljubljana, Slovenia
| | - Massimo Mirandola
- Department of Health, Infectious Disease Section, Verona University Hospital, CReMPE - Regional Coordination Centre for European Project Management, Verona, Veneto Region, Italy
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Blondeel K, de Vasconselos S, García-Moreno C, Stephenson R, Temmerman M, Toskin I. Physical violence based on SOGIE among sexual and gender minorities: a systematic review. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Blondeel
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - S de Vasconselos
- Faculty of Medicine and Health Sciences, Ghent University, Geneva, Switzerland
| | - C García-Moreno
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - R Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, United States
| | - M Temmerman
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - I Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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49
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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 DOI: 10.1136/sextrans-2017-053301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [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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50
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Gliddon HD, Peeling RW, Kamb ML, Toskin I, Wi TE, Taylor MM. A systematic review and meta-analysis of studies evaluating the performance and operational characteristics of dual point-of-care tests for HIV and syphilis. Sex Transm Infect 2017; 93:S3-S15. [PMID: 28747410 PMCID: PMC6754342 DOI: 10.1136/sextrans-2016-053069] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/07/2017] [Accepted: 04/29/2017] [Indexed: 01/03/2023] Open
Abstract
Background Mother-to-child transmission (MTCT) of syphilis and HIV continue to be important yet preventable causes of perinatal and infant morbidity and mortality. Objectives To systematically review, critically appraise and perform a meta-analysis to evaluate the operational characteristics of dual rapid diagnostic tests (RDTs) for HIV/syphilis and evaluate whether they are cost effective, acceptable and easy to use. Design Systematic review and meta-analysis. Data sources We searched seven electronic bibliographic databases from 2012 to December 2016 with no language restrictions. Search keywords included HIV, syphilis and diagnosis. Review methods We included studies that evaluated the operational characteristics of dual HIV/syphilis RDTs. Outcomes included diagnostic test accuracy, cost effectiveness, ease of use and interpretation and acceptability. All studies were assessed against quality criteria and assessed for risk of bias. Results Of 1914 identified papers, 18 were included for the meta-analysis of diagnostic accuracy for HIV and syphilis. All diagnostic accuracy evaluation studies showed a very high sensitivity and specificity for HIV and a lower, yet adequate, sensitivity and specificity for syphilis, with some variation among types of test. Dual screening for HIV and syphilis was more cost effective than single rapid tests for HIV and syphilis and prevented more adverse pregnancy outcomes. Qualitative data suggested dual RDTs were highly acceptable to clients, who cited time to result, cost and the requirement of a single finger prick as important characteristics of dual RDTs. Conclusion The results of this systematic review and meta-analysis can be used by policy-makers and national programme managers who are considering implementing dual RDTs for HIV and syphilis.
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Affiliation(s)
- Harriet D Gliddon
- London Centre for Nanotechnology, University College London, London, UK
| | - Rosanna W Peeling
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Mary L Kamb
- Division of STD Prevention, Center for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Teodora E Wi
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Melanie M Taylor
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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