Abstract

BackgroundPoint-of-care testing for sexually transmitted infections (STIs) may improve diagnosis and treatment of STIs in low- and middle-income counties. We explored the facilitators and barriers to point-of-care testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoea (NG) for youth in community-based settings in Zimbabwe.MethodsThis study was nested within a cluster randomised trial of community-based delivery of integrated HIV and sexual and reproductive health services for youth aged 16 to 24 years. On-site CT/NG testing on urine samples using the Xpert® CT/NG test was piloted in four intervention clusters, with testing performed by service providers. On-site testing was defined as sample processing on the same day and site as sample collection. Outcomes included proportion of tests processed on-site, time between sample collection and collection of results, and proportion of clients receiving treatment. In-depth interviews were conducted with nine service providers and three staff members providing study co-ordination or laboratory support to explore facilitators and barriers to providing on-site CT/NG testing.ResultsOf 847 Xpert tests, 296 (35.0%) were performed on-site. Of these, 61 (20.6%) were positive for CT/NG; one (1.6%) received same day aetiological treatment; 33 (54.1%) presented later for treatment; and 5 (8.2%) were treated as a part of syndromic management. There was no difference in the proportion of clients who were treated whether their sample was processed on or off-site (64% (39/61) vs 60% (66/110); p = 0.61). The median (IQR) number of days between sample collection and collection of positive results was 14 (7–35) and 14 (7–52.5) for samples processed on and off-site, respectively,The interviews revealed four themes related to the provision of on-site testing associated with the i) diagnostic device ii) environment, iii) provider, and iv) clients. Some of the specific barriers identified included insufficient testing capacity, inadequate space, as well as reluctance of clients to wait for their results.ConclusionsIn addition to research to optimise the implementation of point-of-care tests for STIs in resource-limited settings, the development of new platforms to reduce analytic time will be necessary to scale up STI testing and reduce the attrition between testing and treatment.Trial registrationRegistered in clinical trials.gov (NCT03719521).

Highlights

  • Point-of-care testing for sexually transmitted infections (STIs) may improve diagnosis and treatment of Sexually transmitted infections (STIs) in low- and middle-income counties

  • Some of the specific barriers identified included insufficient testing capac‐ ity, inadequate space, as well as reluctance of clients to wait for their results

  • In addition to research to optimise the implementation of point-of-care tests for STIs in resource-lim‐ ited settings, the development of new platforms to reduce analytic time will be necessary to scale up STI testing and reduce the attrition between testing and treatment

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Summary

Introduction

Point-of-care testing for sexually transmitted infections (STIs) may improve diagnosis and treatment of STIs in low- and middle-income counties. We explored the facilitators and barriers to point-of-care testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoea (NG) for youth in community-based settings in Zimbabwe. The World Health Organization (WHO) African Region was estimated in 2016 to have the highest prevalence for chlamydia (CT) in men, and gonorrhoea (NG) and trichomoniasis in both men and women [1]. A 2021 study amongst youth in community settings in Harare, Zimbabwe revealed CT and/or NG prevalence of 18.2 and 10.0% amongst women and men, respectively [3]. Transmitted infections (STIs) are associated with poor reproductive health outcomes, and an increased risk of HIV transmission [4]. CT and NG infection can cause pelvic inflammatory disease in women with possible sequelae including infertility, risk of ectopic pregnancies and chronic pelvic pain [1]

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