Improved sensitivity from pooled urine, pharyngeal and rectal specimens when using a molecular assay for the detection of chlamydia and gonorrhoea near point of care

Dean, Judith; Bell, Sara Fiona Elisabeth; Coffey, Luke; Debattista, Joseph; Badman, Steven G; Redmond, Andrew; Whiley, David M.; Lemoire, Jime; Williams, Owain David; Howard, Chris; Gilks, Charles F.

doi:10.1136/sextrans-2020-054835

Cited by 7 publications

(12 citation statements)

References 5 publications

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“…Some studies only included positive specimens; thus, negative percent agreement could not be calculated for those studies. 15,17,18,22 One study only tested for CT infection. 20 Our bias investigation using the QUADAS-2 tool generally found a low risk of bias across the 14 included studies (Table 2).…”

Section: Resultsmentioning

confidence: 99%

Pooled 3-Anatomic-Site Testing for Chlamydia trachomatis and Neisseria gonorrhoeae: A Systematic Review and Meta-Analysis

Almeria¹,

Pham²,

Paris³

et al. 2021

Sexual Trans Dis

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Background: Pooled testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) may be a cost-saving solution to increase screening by simplifying testing procedures and reducing resource burdens. We conducted a systematic review and meta-analysis to examine the performance of pooled 3-anatomic-site testing (pharyngeal, rectal, and urogenital sites) for CT and NG in comparison with single-anatomic-site testing. Methods:We conducted a systematic literature search in PubMed, Embase, and Web of Science to identify original evaluation studies of the performance of pooled testing for CT and NG infections and identified 14 studies for inclusion. Each study was systematically evaluated for bias. We conducted bivariate fixed-effects and random-effects meta-analyses using a full Bayesian method of the positive percent agreement and negative percent agreement. Results:The combined positive percent agreement for CT was 93.11% (95% confidence interval [CI], 91.51%-94.55%), and the negative percent agreement was 99.44% (95% CI, 99.18%-99.65%). For NG, the combined positive percent agreement was 93.80% (95% CI, 90.26%-96.61%), and the negative percent agreement was 99.73% (95% CI, 99.30%-99.97%). Conclusions:We found that pooled 3-anatomic-site tests performed similarly to single-anatomic-site tests for the detection of CT and NG. The pooled 3-anatomic-site tests have the added potential benefit of reduced cost and resource requirement, which could lead to improved testing access and screening uptake.

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Section: Resultsmentioning

confidence: 99%

Pooled 3-Anatomic-Site Testing for Chlamydia trachomatis and Neisseria gonorrhoeae: A Systematic Review and Meta-Analysis

Almeria¹,

Pham²,

Paris³

et al. 2021

Sexual Trans Dis

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“…Eight studies discussed the health equity impacts pooling could bring by increasing the testing coverage [ 15 , 20 , 21 , 23 , 26 – 28 ], especially for asymptomatic individuals who would not have been tested otherwise in low- and middle-income countries such as countries in West Africa [ 21 ]. De Baetselier et al [ 21 ] suggested that pooled testing should be incorporated in PrEP programs in resource-limited countries due to the potential to decrease HIV transmission.…”

Section: Resultsmentioning

confidence: 99%

“…Considerations include the transport and handling of samples, mixing of samples, the amount of diluent used, potential contamination of samples, laboratory staff training, and the storage of individual samples for re-testing if required [ 15 , 20 ]. Finally, with lower bacterial load in the oropharynx compared to the genital and anorectal sites [ 33 ], there is a potential for pooled testing to miss oropharyngeal infections [ 13 , 26 , 27 , 34 ]. Future studies should investigate how to further optimize detection of oropharyngeal infections.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of pooling urine, anorectal, and oropharyngeal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analysis

Aboud

Chow

et al. 2021

BMC Med

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Background Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at genital and extragenital sites is needed for most key populations, but molecular diagnostic tests for CT/NG are costly. We aimed to determine the accuracy of pooled samples from multiple anatomic sites from one individual to detect CT/NG using the testing of a single sample from one anatomic site as the reference. Methods In this systematic review and meta-analysis, we searched five databases for articles published from January 1, 2000, to February 4, 2021. Studies were included if they contained original data describing the diagnostic accuracy of pooled testing compared with single samples, resource use, benefits and harms of pooling, acceptability, and impact on health equity. We present the pooled sensitivities and specificities for CT and NG using a bivariate mixed-effects logistic regression model. The study protocol is registered in PROSPERO, an international database of prospectively registered systematic reviews (CRD42021240793). We used GRADE to evaluate the quality of evidence. Results Our search yielded 7814 studies, with 17 eligible studies included in our review. Most studies were conducted in high-income countries (82.6%, 14/17) and focused on men who have sex with men (70.6%, 12/17). Fourteen studies provided 15 estimates for the meta-analysis for CT with data from 5891 individuals. The pooled sensitivity for multisite pooling for CT was 93.1% [95% confidence intervals (CI) 90.5–95.0], I2=43.3, and pooled specificity was 99.4% [99.0–99.6], I2=52.9. Thirteen studies provided 14 estimates for the meta-analysis for NG with data from 6565 individuals. The pooled sensitivity for multisite pooling for NG was 94.1% [95% CI 90.9–96.3], I2=68.4, and pooled specificity was 99.6% [99.1–99.8], I2=83.6. Studies report significant cost savings (by two thirds to a third). Conclusion Multisite pooled testing is a promising approach to improve testing coverage for CT/NG in resource-constrained settings with a small compromise in sensitivity but with a potential for significant cost savings.

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“…A single-site implementation study with an embedded mixed-methods monitoring and evaluation (M&E) [ 33 ] was conducted by a multidisciplinary team of peers, clinicians, and researchers from The University of Queensland (UQ) and Queensland Positive People (QPP)—a peer-led HIV-community-based organisation that has been providing on-site peer-facilitated asymptomatic HIV and syphilis POCT since 2014 [ 16 ] and, more recently, molecular POCT for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) [ 34 , 35 , 36 ].…”

Section: Methodsmentioning

confidence: 99%

Online HIV Self-Testing (HIVST) Dissemination by an Australian Community Peer HIV Organisation: A Scalable Way to Increase Access to Testing, Particularly for Suboptimal Testers

Bell

Lemoire²,

Debattista

et al. 2021

IJERPH

Self Cite

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HIV self-testing (HIVST) introduces opportunities for screening in non-conventional settings, and addresses known testing barriers. This study involved the development and evaluation of a free online HIVST dissemination service hosted by a peer-led, community-based organisation with on-site, peer-facilitated HIV testing, and established referral and support programs for people newly diagnosed with HIV to determine whether this model was feasible and acceptable for engaging MSM, particularly among infrequent and naive HIV-testers, or those living in remote and rural areas. Between December 2016 and April 2018, 927 kits were ordered by 794 individuals, the majority of whom were men who have sex with men (MSM) (62%; 494), having condomless sex (50%; 392), or living outside a major city (38%; 305). Very few (5%; 39) sought the available pre-test peer contact, despite 45% (353) being naive HIV-testers. This study demonstrates that online HIVST dissemination is acceptable and feasible for engaging at-risk suboptimal testers, including those unwilling to test elsewhere (19%; 47/225). With half (50%; 403) unwilling to buy a kit, our study suggests that HIVST will need to be subsidized (cost-neutral to users) to enhance population coverage and access.

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Improved sensitivity from pooled urine, pharyngeal and rectal specimens when using a molecular assay for the detection of chlamydia and gonorrhoea near point of care

Cited by 7 publications

References 5 publications

Pooled 3-Anatomic-Site Testing for Chlamydia trachomatis and Neisseria gonorrhoeae: A Systematic Review and Meta-Analysis

Pooled 3-Anatomic-Site Testing for Chlamydia trachomatis and Neisseria gonorrhoeae: A Systematic Review and Meta-Analysis

Diagnostic accuracy of pooling urine, anorectal, and oropharyngeal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analysis

Online HIV Self-Testing (HIVST) Dissemination by an Australian Community Peer HIV Organisation: A Scalable Way to Increase Access to Testing, Particularly for Suboptimal Testers

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