STIs in CHIEDZA

性传播感染(STI)在青春期感染时，可能会危及晚年的性健康和生殖健康，对妇女来说，也会危及她们婴儿的健康。在发展中国家，症状性传播感染是通过症状性管理(对有症状的患者进行推定治疗而不使用实验室检测)进行治疗的。发展综合征候群管理是因为发展中国家无法获得性传播感染的诊断测试。然而，研究表明，治疗常见的性传播感染，如衣原体和淋病，症状处理的准确性很低--特别是对女性。这是因为大多数患有衣原体和淋病的妇女没有任何症状。然而，这些感染可能会产生毁灭性的后果，如妊娠并发症、不孕不育和艾滋病毒传播增强。因此，在艾滋病毒和性传播感染流行的发展中国家，对青少年和年轻人进行有效的性传播感染控制是一个关键的优先事项。整合到HIV预防和检测服务中的较新的STI诊断可能提供解决方案。我们计划在津巴布韦一项名为Chiedza的青少年和年轻人随机对照试验(AYP)中使用较新的STI诊断方法来评估STI筛查干预。Chiedza是一个以社区为基础的一揽子性生殖健康服务，包括艾滋病毒预防、艾滋病毒检测、与照顾16至24岁AYP的联系。我们的干预措施将使用护理点或接近护理点的测试对三种最常见的可治愈的性传播感染(衣原体、淋病和滴虫病)进行筛查。这项研究是及时的：世卫组织正在更新性传播感染病例管理指南并重新审查综合征病例管理。需要强有力的证据来整合AYP较新的检测技术来为这些指南提供依据。我们的问题是1.AYP中基于社区的STI筛查的接受率、患病率和收益如何？所有Chiedza参与者都将接受衣原体和淋病筛查，年轻女性也将接受滴虫病检测。结果将是摄取率、流行率(筛查者的性传播感染阳性比例)和产量(符合筛查者的性传播感染阳性比例)。2.以社区为基础的性传播感染筛查和综合管理对青壮年人群水平的性传播感染患病率有何影响？在干预期结束后，计划对Chiedza试验进行一次以人口为基础的横断面调查。在横断面调查中，将对随机抽样的参与者增加STI测试。主要结果将是使用CRT分析的两阶段方法比较干预组和控制组中衣原体、淋病或滴虫病检测呈阳性的个人的百分比。风险评估工具能否预测无症状AYP的STI阳性？在性传播感染筛查干预期间，将收集有关风险和生殖器症状的数据。将使用For k重交叉验证方法开发自我评估工具。结果将是评估工具对STI阳性的敏感性、特异性、阳性预测值和阴性预测值。以社区为基础的性传播感染筛查和综合管理是否具有成本效益？我们将衡量我们的干预与综合征候群管理相比的成本效益。以社区为基础的性传播感染筛查和综合管理可以接受吗？需要解决哪些因素，以确保干预措施能够在国家一级得到扩大和持续，如果它有效的话？我们将进行流程评估，以了解我们的干预措施是如何运作的，客户和供应商是否可以接受，特别是了解需要考虑哪些因素，以确保干预措施如果被证明有效，可以在全国范围内广泛传播。

Sexually transmitted infections (STI), when acquired in adolescence, can jeopardize sexual and reproductive health later in life, and for women, the health of their babies. In developing countries, symptomatic STIs are treated by syndromic management (presumptive treatment of symptomatic patients without the use of laboratory tests). Syndromic management was developed because diagnostic tests for STIs were unavailable in developing countries. However, research has shown that the accuracy of syndromic management for treating common STIs, like chlamydia and gonorrhoea, is low - especially for women. This is because most women with chlamydia and gonorrhoea do not have any symptoms. Yet these infections can have devastating outcomes such as pregnancy complications, infertility, and enhanced HIV transmission. Thus, effective STI control in adolescents and young people is a key priority in developing countries where both HIV and STIs are prevalent. Newer STI diagnostics integrated into HIV prevention and testing services may provide a solution.We plan to evaluate a STI screening intervention using newer STI diagnostic methods within a cluster randomised controlled trial among adolescents and young people (AYP) in Zimbabwe, called CHIEDZA. CHIEDZA is a community-based package of sexual reproductive health services incorporating HIV prevention, HIV testing, linkage to care for AYP aged 16 to 24 years. Our intervention will provide screening for the three most prevalent curable STIs (chlamydia, gonorrhoea and trichomoniasis) using point-of-care or near point-of-care tests.This study is timely: WHO is in the process of updating their STI case management guidelines and revisiting syndromic case management. Robust evidence for integrating newer testing technologies for AYP is needed to inform these guidelines.Our questions are 1. What is the uptake, prevalence and yield of community-based STI screening among AYP?All CHIEDZA attendees will be offered chlamydia and gonorrhoea screening and young women will also be offered testing for trichomoniasis. The outcome will be uptake, prevalence (proportion positive for an STI of those screened) and yield (proportion positive for an STI of those eligible for screening). 2. What is the impact of community-based STI screening and comprehensive management on population level STI prevalence among AYP? A population-based cross-sectional survey is planned for the CHIEDZA trial following the intervention period. STI testing will be added for a random sub-sample of participants in the cross-sectional survey. The primary outcome will be a comparison of the percentage of individuals with a positive test for chlamydia, gonorrhoea or trichomoniasis between intervention and control clusters using the two-stage approach for analysis of CRTs.3. Can a risk assessment tool predict STI positivity among asymptomatic AYP? During the STI screening intervention, data on risks and genital symptoms will be collected. A self-assessment tool will be developed using for k-fold cross validation methods. The outcome will be sensitivity, specificity, positive predictive value and negative predictive value of the assessment tool for STI positivity.4. Is community-based STI screening and comprehensive management cost-effective? We will measure how cost-effective our intervention is compared to syndromic management.5. Is community-based STI screening and comprehensive management acceptable and what factors need to be addressed to ensure that the intervention can be scaled-up and sustained at a national level if it is effective? We will conduct a process evaluation to understand how our intervention works, whether it is acceptable to clients and providers and specifically to understand the factors that would need to be considered to ensure the intervention could be delivered widely within the country if it was proven effective.