An Integrated Care Model With Implementation Roadmap to Improve Chlamydia trachomatis Management and Control in India

Abstract

Chlamydia trachomatis is the world's most prevalent bacterial Sexually Transmitted infection (STI). It is associated with a wide range of health consequences and sequelae in both the short and long term. Enhanced control of urogenital C. trachomatis infection is particularly important in low- and middle-income countries such as India, where most of the burden goes unnoticed and where limited systematic data is available to gauge the current situation. The World Health Organization (WHO) recently issued its latest strategy on STIs, which is aligned with the achievement of the Sustainable Development Goals (SDGs). Taking the WHO framework into account; this paper puts forward an integrated care model to strengthen the management and control of C. trachomatis in India. The model is compiled of five key components of STI management (awareness, prevention diagnosis, treatment and follow-up). The model considers barriers to effective C. trachomatis control into account. The barriers are discussed and compiled into different categories. A roadmap for the implementation of other similar models to enhance C. trachomatis control in the future is provided.

The Prevalence of Chlamydia trachomatis and Three Other Non-Viral Sexually Transmitted Infections among Pregnant Women in Pemba Island Tanzania

“…As previously mentioned, these four studied non-viral STIs continue to have an impact on maternal health and pregnancy outcomes in various countries [55,56]. The approach to diagnosis and managing them should align with global STI eradication strategies, depending on the available resources and epidemiological information per country [56,57]. In this low-resource setting, where antenatal and health care is limited, and maternal and infant morbidity is high, it is important to understand the burden of (curable) pathogens that might cause long-term impact on female reproductive health beyond pregnancy, causing, for instance, ectopic pregnancy or successive infertility [57,58].…”

“…The approach to diagnosis and managing them should align with global STI eradication strategies, depending on the available resources and epidemiological information per country [56,57]. In this low-resource setting, where antenatal and health care is limited, and maternal and infant morbidity is high, it is important to understand the burden of (curable) pathogens that might cause long-term impact on female reproductive health beyond pregnancy, causing, for instance, ectopic pregnancy or successive infertility [57,58]. Establishing the burden of these pathogens through epidemiological biobank data-driven research in (a)symptomatic populations is an important first step for the management and control of the burden of pathogen-related diseases in communities, including in Pemba Island [57].…”

“…In this low-resource setting, where antenatal and health care is limited, and maternal and infant morbidity is high, it is important to understand the burden of (curable) pathogens that might cause long-term impact on female reproductive health beyond pregnancy, causing, for instance, ectopic pregnancy or successive infertility [57,58]. Establishing the burden of these pathogens through epidemiological biobank data-driven research in (a)symptomatic populations is an important first step for the management and control of the burden of pathogen-related diseases in communities, including in Pemba Island [57]. However, more opportunities to strengthen the diagnostic capacity and further investigate the burden of pathogens, for instance, through hospitals and health care institution databases, are needed, with particular attention to the data from pregnant women between 35 and 49 years.…”

Sexually transmitted infections in pregnant women from sub-Saharan Africa

“… 11 , 30 , 47 In SSA, where antenatal and healthcare are limited and maternal and infant morbidity is high, it is important to understand the burden of STIs and its impact on female reproductive health, maternal health and neonatal consequences. 48 , 49 Most recently, in developing countries because of STIs, the WHO reported a stillbirth rate of 25.6 per 1000 births in 2009 and a neonatal mortality rate of 28 per 1000 births in 2015 compared to 2.4 and 2.0 in developed countries, respectively. 50 Recently published data showed that in numerous regions of the world antenatal screening for STIs is not regularly practiced, particularly in LMICs.…”

Effect of chlamydia trachomatis on infertile women

“…As a result, large-scale screening programs for patients at risk are recommended by countries. (Fox, Dobler, Marais, & Denholm, 2017) Since 70-80% of C. trachomatis infections go unrecognized (Twohig, 2013), prolonged infection may raise the risk for pelvic inflammatory illness, tubal factor associated infertility, and ectopic pregnancy (Lawton et al, 2004;Thomas et al, 2018). All these sequelae can worsen tubal disease, reducing the possibility of conception after tubal flushing.…”