To Pool or Not to Pool Samples for Sexually Transmitted Infections Detection in Men Who Have Sex With Men? An Evaluation of a New Pooling Method Using the GeneXpert Instrument in West Africa

Baetselier, Irith De; Vuylsteke, Béa; Yaya, Issifou; Dagnra, Anoumou Claver; Diandé, Souba; Mensah, Ephrem; Dah, Elias; Anoma, Camille; Koné, A.; Faye-Ketté, H.; Yeo, Alain; Keïta, Bintou Dembélé; Laurent, Christian; Crucitti, Tania

doi:10.1097/olq.0000000000001191

Cited by 17 publications

(17 citation statements)

References 32 publications

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“…This discrepancy may reflect participant unfamiliarity with the possibility of anorectal sexually transmitted infections (STIs) [31], concern for physical discomfort with sampling at this anatomic site [32] and psychological discomfort addressing anal sexual health within potentially stigmatizing healthcare systems [33]. Consistent with prior reports from other parts of sub‐Saharan Africa [34‐37], the high burden of asymptomatic infections in this cohort highlights the limitations of syndromic surveillance and suggests the need for presumptive testing and/or treatment to address the STI epidemic among MSM and TGW in South Africa.…”

Section: High Incidence Of Hiv and Other Sexually Transmitted Infectisupporting

confidence: 57%

Involvement of African men and transgender women who have sex with men in HIV research: progress, but much more must be done

Crowell

Fast

Bekker

et al. 2020

J. Intern. AIDS Soc.

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Section: High Incidence Of Hiv and Other Sexually Transmitted Infectisupporting

confidence: 57%

Involvement of African men and transgender women who have sex with men in HIV research: progress, but much more must be done

Crowell

Fast

Bekker

et al. 2020

J. Intern. AIDS Soc.

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“…Whilst they acknowledged that the costs of each assay varied according to different laboratories, they proposed that pooled testing offers cost savings of up to two thirds of the costs of the assays alone, as well as savings in consumables, processing time, and clinical pathway efficacy. De Baetselier et al [ 21 ] assessed the efficacy of pooled testing among 497 MSM in four West African countries. They demonstrated a 56% decrease in cost when un-pooling of triple-site pooling was only undertaken when the pooled sample result was invalid.…”

Section: Resultsmentioning

confidence: 99%

“…Six studies conducted in the UK, Australia, West Africa, and Belgium discussed the possible adverse events of multisite pooled testing. One universal issue was that pooled testing failed to provide site-specific information without retesting individuals, potentially limiting site-specific treatment choices [ 13 , 15 , 20 , 21 , 23 , 24 ]. For example, if the details of site-specific infection were available, anorectal chlamydia would be treated with doxycycline instead of azithromycin [ 13 , 20 ].…”

Section: Resultsmentioning

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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“…However, endemic regions may qualify for a price discount and the GeneXpert platform is already established in many LMIC for tuberculosis and other pathogens, such as HIV and other sexually-transmitted infections (73)(74)(75)(76). HBV and HCV cartridges are available for viral load (VL) quantification in serum/plasma or by fingerstick (HCV only) and thus are applicable as a near-patient POC test that would be performed in a healthcare facility for patient management purposes.…”

Section: Nucleic-acid-based Rdtmentioning

confidence: 99%

Rapid Diagnostics for Hepatitis B and C Viruses in Low- and Middle-Income Countries

Shenge¹,

Osiowy

2021

Front.Virol.

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The global health challenge posed by hepatitis B virus (HBV) and hepatitis C virus (HCV) persists, especially in low-and-middle-income countries (LMICs), where underdiagnosis of these viral infections remains a barrier to the elimination target of 2030. HBV and HCV infections are responsible for most liver-related mortality worldwide. Infected individuals are often unaware of their condition and as a result, continue to transmit these viruses. Although conventional diagnostic tests exist, in LMIC they are largely inaccessible due to high costs or a lack of trained personnel, resulting in poor linkage to care and increased infections. Timely and accurate diagnosis is needed to achieve elimination of hepatitis B and C by the year 2030 as set out by the World Health Organization Global Health Sector Strategy. In this review rapid diagnostic tests allowing for quick and cost-effective screening and diagnosis of HBV and HCV, are discussed, as are their features, including suitability, reliability, and applicability in LMIC, particularly those within Africa.

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To Pool or Not to Pool Samples for Sexually Transmitted Infections Detection in Men Who Have Sex With Men? An Evaluation of a New Pooling Method Using the GeneXpert Instrument in West Africa

Abstract: To pool or not to pool samples for Sexually Transmitted Infections detection in Men who have Sex with Men? An evaluation of a new pooling method using the GeneXpert instrument in West-Africa.

Cited by 17 publications

References 32 publications

Involvement of African men and transgender women who have sex with men in HIV research: progress, but much more must be done

Involvement of African men and transgender women who have sex with men in HIV research: progress, but much more must be done

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

Rapid Diagnostics for Hepatitis B and C Viruses in Low- and Middle-Income Countries

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