Shifting the power: scale-up of access to point-of-care and self-testing for sexually transmitted infections in low-income and middle-income settings

Abstract

Purpose of reviewPoint-of-care (POC) testing for sexually transmitted infections (STIs) can provide complementary coverage to existing HIV testing services in LMICs. This review summarizes current and emerging technologies for detecting STIs in LMICs, with an emphasis on women, discharge-causing infections (chlamydia, gonorrhoea, trichomoniasis, and syphilis), true POC, self-testing, ethics, and economic considerations related to equitable access.Recent findingsThe WHO have recently adapted guidelines for treatment of STIs in women that advise the use of true-POC or near-POC tests to improve case finding. The number of rapid, sensitive, and specific POC diagnostics for STIs has increased significantly over the past 10 years, although adoption of these in low-income and middle-income countries (LMICs) remains limited. Barriers to POC adoption by patients include the cost of tests, the inconvenience of lengthy clinic visits, low perceived risk, stigma, lack of partner notification, and lack of trust in healthcare providers. Lowering the cost of true POC lateral flow devices, interfacing these with digital or eHealth technologies, and enabling self-testing/self-sampling will overcome some of these barriers in LMICs. Ensuring linkage of diagnostic tests to subsequent care remains one of the major concerns about self-testing, irrespective of geography, although available evidence from HIV self-testing suggests that linkage to care is similar to that for facility-based testing.SummaryIncreasing access to sensitive STI true POC tests will strengthen reproductive healthcare in LMICs. Although HIV self-testing is demonstrably useful in LMICs, there is an urgent need for randomized trials evaluating the utility and cost-effectiveness of similar tests for other sexually transmitted infections.

Shifting Grounds—Facilitating Self-Care in Testing for Sexually Transmitted Infections Through the Use of Self-Test Technology: Qualitative Study

“…The co-design process that led to the development and implantation of the STT ensured that the solution was integrated into existing clinical workflows and that HCPs and patients supported it. These critical aspects must be addressed to ensure the adoption and implementation of new technologies for STI testing [22]. Khumalo et al state that if new technologies are implemented correctly, patients will be provided with autonomy and be empowered to take control of their sexual health because barriers towards testing, such as stigma, can be reduced.…”

Advances in mass spectrometry technologies to characterize cervicovaginal microbiome functions that impact spontaneous preterm birth

“…33 There is also a wide range of tests for different STIs, although, aside from syphilis diagnostics, and initial antenatal screening appointments, generally these are only utilised if women are symptomatic. 49 However, despite a significant number of studies that have sought to identify the causes of sPTB, there remain major gaps in our knowledge and, with the exception of cervical screening to identify women with a short cervix who may benefit from treatment with vaginal progesterone and/or cervical cerclage (∼2% of all women 50 ), there are no existing reliable diagnostics to predict sPTB long before it occurs, enabling timely intervention. The bacteria associated with sPTB differ between studies and appear to vary significantly at the individual level, dependent on many factors, including specific combinations of bacteria, strains of bacteria, bacterial load, sites of bacterial localization, kinetics and timing of infection, the level of inflammation induced, as well as ethnicity and geographical region.…”

“…during mid‐pregnancy and has been shown to be capable of predicting up to 45% of sPTB cases in a Caucasian population 33 . There is also a wide range of tests for different STIs, although, aside from syphilis diagnostics, and initial antenatal screening appointments, generally these are only utilised if women are symptomatic 49 …”