Same-Day Treatment Following Point-of-Care Sexually Transmitted Infection Testing in Different Healthcare Settings in South Africa

Mdingi, Mandisa; Peters, Remco P. H.; Gigi, Ranjana M. S.; Babalola, Chibuzor M; Taylor, Christopher M.; Muzny, Christina A; Low, Nicola; Medina-Marino, Andrew; Klausner, Jeffrey D.

doi:10.1093/cid/ciac974

Cited by 3 publications

(2 citation statements)

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“…Research studies using in-facility Xpert assay testing have shown major benefits of STI point-of-care diagnostic testing on the time to treatment in syndromic manage ment settings. [23][24][25][26] Another recent development is the Visby Medical Sexual Health Test; a rapid singleuse molecular point-of-care test for multiple STIs. 27 Despite high test performance of these assays, molecular test technology is likely to remain too expensive for widespread use in lower-income settings.…”

Section: Discussionmentioning

confidence: 99%

Novel lateral flow assay for point-of-care detection of Neisseria gonorrhoeae infection in syndromic management settings: a cross-sectional performance evaluation

Peters,

Klausner,

Mazzola

et al. 2024

The Lancet

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Section: Discussionmentioning

confidence: 99%

Novel lateral flow assay for point-of-care detection of Neisseria gonorrhoeae infection in syndromic management settings: a cross-sectional performance evaluation

Peters,

Klausner,

Mazzola

et al. 2024

The Lancet

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“…Participants were recruited between April and December 2023 from three southern African sites: 1) Cape Town, SA; 2) East London, SA; and 3) Gaborone, Botswana, with antenatal care HIV prevalence estimated from previous studies at 20.3%, 29% and 17%, respectively [52][53][54]. Collaborating healthcare facilities in East London were de ned to cater to peri-urban and rural areas, whereas Cape Town and Gaborone were predominantly characterized as urban.…”

Section: Study Population and Samplingmentioning

confidence: 99%

Service Delivery Preferences for Long-acting Pre-exposure Prophylaxis among Pregnant and Breastfeeding Women in South Africa and Botswana

DE VOS,

MUSSA,

ROUSSEAU

et al. 2024

Preprint

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Objective HIV particularly affects women during pregnancy and postpartum, where they face a two-fold or more increased risk of HIV acquisition. Structural and individual barriers hinder effective use of daily oral pre-exposure prophylaxis (PrEP). We explored preferences for long-acting PrEP and multipurpose prevention technologies among pregnant and breastfeeding women (PBFW) without HIV. Design Between April and December 2023, we evaluated preferences for long-acting PrEP in a discrete choice experiment among pregnant and breastfeeding, postpartum women accessing maternal services at the primary healthcare level. Methods The study included individuals with prior experience using oral PrEP (Cape Town, South Africa) and those PrEP naive (East London, South Africa, and Gaborone, Botswana). The discrete choice experiment was developed through qualitative interviews and focus group discussions. Analysis included demographic characterization, site stratification, mixed effects logistic regression, and latent class modelling. Results We surveyed 450 pregnant and breastfeeding women (52% pregnant, 47% breastfeeding). Women strongly disfavoured vaginally inserted and implanted PrEP compared to oral PrEP. Preferences varied by study population: clinic PrEP pick-up was preferred in East London and Gaborone, while Cape Town showed more indifference for community delivery. Women in East London and Gaborone prioritized PrEP effectiveness over frequency. Three latent classes emerged: Class 1, ‘comprehensive delivery seekers’ (43%); Class 2, ‘physical and physiological prioritisers’ (25%), and Class 3, ‘vaginal insertion avoiders’ (32%). Conclusions PrEP modality (long-acting), frequency, and pickup location were important factors in PrEP delivery. Future PrEP programs should prioritize user-centered approaches, aligning with user values and preferences to foster effective use.

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Point-of-care testing for sexually transmitted infections and HIV pre-exposure prophylaxis among pregnant women in South Africa, 2021–2022: randomised controlled trial

de Voux,

Nyemba,

Silliman

et al. 2023

Sex Transm Infect

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ObjectivePregnant and postpartum women (PPW) in Southern Africa are at increased risk of acquiring HIV and curable sexually transmitted infections (STIs). Oral pre-exposure prophylaxis (PrEP) is safe and effective to use during pregnancy to reduce HIV acquisition and vertical transmission. Point-of-care (POC) STI testing can identify PPW at risk of HIV and facilitate risk-differentiated and person-centred counselling to improve PrEP initiation, persistence and adherence. We evaluated the impact of POC STI testing compared with STI syndromic management on PrEP outcomes among PPW in Cape Town, South Africa.MethodsThe STI and PrEP in Pregnancy Study enrolled PPW without HIV and ≤34 weeks pregnant at their regular antenatal care visit with follow-up after 1 month. PPW were randomised to receive POC STI testing or STI syndromic management. PPW randomised to POC STI testing self-collected vaginal swabs forChlamydia trachomatis, Neisseria gonorhoeaeandTrichomonas vaginalis(Cepheid GeneXpert) testing and were offered same-day treatment if diagnosed. We compared PrEP initiation at baseline, PrEP prescription refill at 1 month (persistence) and adherence through tenofovir-diphosphate detection in dried blood spots by randomisation arm. In a secondary analysis, we evaluated the association between an STI diagnosis (positive STI test or reporting STI symptoms) with PrEP outcomes.ResultsWe enrolled and randomised 268 pregnant women. Twenty-eight per cent of women were diagnosed with ≥1 STI. Overall, 65% of women initiated and 79% persisted on PrEP with no significant differences by randomisation arm. Secondary analysis demonstrated that an STI diagnosis (positive STI test or reporting STI symptoms) was associated with higher PrEP initiation (adjusted relative risk=1.28; 95% CI 1.08 to 1.52), controlling for arm, maternal and gestational age.ConclusionsPOC STI testing was not associated with PrEP initiation or persistence relative to syndromic management. However, improving STI diagnosis by supplementing syndromic management with POC STI testing could improve PrEP initiation among PPW.Trial registration numberNCT03902418; Clinical Trials.gov; 1 April 2019.

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Same-Day Treatment Following Point-of-Care Sexually Transmitted Infection Testing in Different Healthcare Settings in South Africa

Abstract: We would like to congratulate Asare et al [1] on their analysis of the outcomes of point-of-care (POC) testing for sexually transmitted infections (STIs) among women in South Africa during an HIV vaccine trial. They found that, in one clinic, 92% of women with a positive test result for

Cited by 3 publications

References 2 publications

Novel lateral flow assay for point-of-care detection of Neisseria gonorrhoeae infection in syndromic management settings: a cross-sectional performance evaluation

Novel lateral flow assay for point-of-care detection of Neisseria gonorrhoeae infection in syndromic management settings: a cross-sectional performance evaluation

Service Delivery Preferences for Long-acting Pre-exposure Prophylaxis among Pregnant and Breastfeeding Women in South Africa and Botswana

Point-of-care testing for sexually transmitted infections and HIV pre-exposure prophylaxis among pregnant women in South Africa, 2021–2022: randomised controlled trial

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