Beyond syndromic management: Opportunities for diagnosis-based treatment of sexually transmitted infections in low-and middle-income countries
Beyond syndromic management: Opportunities for diagnosis-based treatment of sexually transmitted infections in low-and middle-income countries
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DOI：
10.1371/journal.pone.0196209
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发表时间：
2018-04-24
期刊：
影响因子：
3.7
通讯作者：
Mindel, Adrian
中科院分区：
文献类型：
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作者：
Garrett, Nigel J.;Osman, Farzana;Mindel, Adrian
鉴于综合征管理方法对全球性传播感染（STI）流行的影响有限，我们评估了一种护理模式，包括床旁（POC）STI检测，立即治疗，和快速伴侣治疗（EPT）在南非的一个队列的年轻妇女在艾滋病毒高风险。方法和发现艾滋病毒阴性妇女提出的性病护理进行POC检测沙眼衣原体（CT）、淋病奈瑟菌（NG）和阴道毛滴虫（TV），并将拭子送去进行NG培养和药敏试验。结果在2小时内公布，患有性传播感染的妇女立即得到治疗，并提供EPT包，包括药物、避孕套和性伴侣信息。一周后进行EPT问卷调查，6周和12周后对女性进行性传播感染重新测试。招募了267名女性，中位年龄23岁（IQR 21-26），88.4%（236/267）报告了生殖器症状。STI患病率为CT 18.4%（95% CI 13.7-23.0）、NG 5.2%（95% CI 2.6-7.9）和TV 3.0%（95% CI 1.0-5.0）。12周后，除1例NG和2例CT感染外，所有感染均被清除。未检出耐头孢菌素NG。在63/267名诊断为性传播感染的妇女（23.6%）中，98.4%（62/63）接受了EPT治疗，87.1%（54/62）接受了EPT治疗。在一周时，88.9%（48/54）的人表示他们的伴侣服用了药物。未报告过敏反应或社会危害。在完成6周随访的51名女性中，接受EPT的女性（2.2%，1/46）的检出率低于未接受EPT的女性（40.0%，2/5），p = 0.023。在焦点小组讨论妇女支持的护理模式，因为他们得到了快速，具体的诊断，并可以方便他们的合作伙伴的treatment.ConclusionsPOC性病检测和EPT是可以接受的年轻南非妇女和他们的合作伙伴，并可以发挥重要作用，减少性病再感染率和艾滋病毒的风险。更大规模的研究应评估在人口一级实施这一战略的可行性和成本效益。
IntroductionIn light of the limited impact the syndromic management approach has had on the global sexually transmitted infection (STI) epidemic, we assessed a care model comprising pointof- care (POC) STI testing, immediate treatment, and expedited partner therapy (EPT) among a cohort of young women at high HIV risk in South Africa.Methods and findingsHIV negative women presenting for STI care underwent POC testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV), and swabs were sent for NG culture and susceptibility testing. Results were available within 2 hours and women with STIs were immediately treated and offered EPT packs, including medication, condoms, and information for sexual partners. An EPT questionnaire was administered after one week, and women retested for STIs after 6 and 12 weeks. 267 women, median age 23 (IQR 21-26), were recruited and 88.4% (236/267) reported genital symptoms. STI prevalence was CT 18.4% (95% CI 13.7-23.0), NG 5.2% (95% CI 2.6-7.9) and TV 3.0% (95% CI 1.0-5.0). After 12 weeks, all but one NG and two CT infections were cleared. No cephalosporin- resistant NG was detected. Of 63/267 women (23.6%) diagnosed with STIs, 98.4% (62/63) were offered and 87.1% (54/62) accepted EPT. At one week 88.9% (48/54) stated that their partner had taken the medication. No allergic reactions or social harms were reported. Of 51 women completing 6-week follow up, detection rates were lower amongst women receiving EPT (2.2%, 1/46) compared to those who did not (40.0%, 2/5), p = 0.023. During focus group discussions women supported the care model, because they received a rapid, specific diagnosis, and could facilitate their partners' treatment.ConclusionsPOC STI testing and EPT were acceptable to young South African women and their partners, and could play an important role in reducing STI reinfection rates and HIV risk. Larger studies should evaluate the feasibility and cost-effectiveness of implementing this strategy at population level.