Acceptability, feasibility and cost of point of care testing for sexually transmitted infections among South African adolescents where syndromic management is standard of care

Rebecca Marcus; Pike C; K Gill; P Smith; S Rouhani; A Mendelsohn; E Mendel; N Lince-Deroche; K Naidoo; N Ahmed; O Stirrup; J Roseleur; R Leuner; G Meyer-Rath; L G Bekker

doi:10.1186/s12913-023-10068-8

Acceptability, feasibility and cost of point of care testing for sexually transmitted infections among South African adolescents where syndromic management is standard of care

BMC Health Serv Res. 2023 Oct 10;23(1):1078. doi: 10.1186/s12913-023-10068-8.

Authors

Rebecca Marcus^{1

2}, Pike C³, K Gill³, P Smith³, S Rouhani³, A Mendelsohn³, E Mendel³, N Lince-Deroche⁴, K Naidoo³, N Ahmed^{3

5}, O Stirrup⁶, J Roseleur⁴, R Leuner⁴, G Meyer-Rath^{4

7}, L G Bekker³

Affiliations

¹ Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa. rebeccamarcus@nhs.net.
² North Middlesex University Hospital, London, UK. rebeccamarcus@nhs.net.
³ Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
⁴ Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa.
⁵ Mortimer Market Centre, Central North West London NHS Trust, London, UK.
⁶ Institute for Global Health, University College London, London, UK.
⁷ Department of Global Health, School of Public Health, Boston University, Massachusetts, USA.

Abstract

Background: Young people (YP) in southern Africa are at substantial risk of HIV and sexually transmitted infections (STIs). Despite the epidemiological and biological link between STIs and HIV transmission and acquisition, infections such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) remain widely undiagnosed. Syndromic STI management is the standard of care in low- and middle-income countries (LMICs) despite a high prevalence of asymptomatic infections. We conducted an observational study to explore the acceptability, feasibility, and cost of a STI test-and-treat service for YP in Cape Town.

Methods: YP attending a mobile clinic (MC) and a youth centre clinic (YC) were offered STI screening. Urine testing for CT and NG using a 90-min molecular point-of-care (POC) test on the GeneXpert platform was conducted and treatment provided. Data were collated on demographics, sexual behaviour, presence of symptoms, uptake of same-day treatment, prevalence of CT/NG, and service acceptability.

Results: Three hundred sixty six participants were enrolled (median age 20, 83% female).57% (209/366) of participants tested positive for either CT (126/366, 34%) or NG (57/366, 16%) or co-infection (26/366, 7%). Clinical symptoms were a poor predictor of GeneXpert diagnosed CT or NG, with a sensitivity of 46.8% and 54.0% for CT and NG respectively. Although half of participants initially chose to receive same day results and treatment, only a third waited for results on the day. The majority of participants (91%) rated the service highly via a post-visit acceptability questionnaire.

Conclusion: Curable STIs are highly prevalent in this population. STI screening using POC testing was feasible and acceptability was high. The study provides further impetus for moving policy beyond syndromic management of STIs in South Africa.

Keywords: Adolescents; Costs; STIs; South Africa.

Publication types

Observational Study

MeSH terms

Adolescent
Adult
Chlamydia Infections* / diagnosis
Chlamydia Infections* / epidemiology
Chlamydia trachomatis
Feasibility Studies
Female
Gonorrhea* / diagnosis
Gonorrhea* / epidemiology
HIV Infections* / diagnosis
HIV Infections* / epidemiology
HIV Infections* / prevention & control
Humans
Male
Neisseria gonorrhoeae
Point-of-Care Testing
Prevalence
Sexually Transmitted Diseases* / diagnosis
Sexually Transmitted Diseases* / epidemiology
Sexually Transmitted Diseases* / prevention & control
South Africa / epidemiology
Standard of Care
Young Adult