Sexually transmitted infection point-of-care testing in resource-limited settings: a narrative review guided by an implementation framework

Abstract

Most sexually transmitted infections (STIs) are acquired in resource-limited settings (RLS) where laboratory diagnostic access is limited. Advancements in point-of-care testing (POC) technology have the potential to bring STI testing to many RLS. We define POC as performed near the patient and with results readily available to inform clinical practice. The World Health Organization Special Programme for Research and Training in Tropical Diseases further outlines desirable POC characteristics with the REASSURED criteria. Despite advantages related to immediate test-and-treat care, integrating POC into RLS healthcare systems can present challenges that preclude reliance on these tests. In 2018, we incorporated molecular near-POC for chlamydia, gonorrhea, and trichomoniasis and SDBioline Treponemal immunochromatographic testing confirmed by rapid plasma reagin for syphilis diagnosis at the Mbarara University of Science and Technology Research Laboratory in rural southwestern Uganda. We describe our experiences with STI POC as a case example to guide a narrative review of the field using the Consolidated Framework for Implementation Research as a conceptual framework. Though POC and near-POC are described as easy to use, the challenges of limited person-power, healthcare processes, limited infrastructure/resources, high costs, and quality control obstacles can impede the impact of these tests. Increased investment in operators, training, and infrastructure, restructuring healthcare systems to accommodate increased POC access, and optimizing costs are all crucial to the successful implementation of STI POC in RLS. Expanded STI POC in RLS will increase access to accurate diagnoses, appropriate treatment, and engagement in partner notification, treatment, and prevention efforts.

Cervical HPV Infections, Sexually Transmitted Bacterial Pathogens and Cytology Findings—A Molecular Epidemiology Study

“…However, several factors contribute in suboptimal STI control globally (their relapsing nature, unreliable assays, limited access to health facilities, inadequate infrastructures, possible effects of sexual networks, immunosuppression, etc.) [55][56][57].…”