Impact of Point-of-Care Testing on the Management of Sexually Transmitted Infections in South Africa: Evidence from the HVTN702 Human Immunodeficiency Virus Vaccine Trial

Clin Infect Dis. 2023 Mar 4;76(5):881-889. doi: 10.1093/cid/ciac824.

Abstract

Background: Alternative approaches to syndromic management are needed to reduce rates of sexually transmitted infections (STIs) in resource-limited settings. We investigated the impact of point-of-care (POC) versus central laboratory-based testing on STI treatment initiation and STI adverse event (STI-AE) reporting.

Methods: We used Kaplan-Meier and Cox regression models to compare times to treatment initiation and STI-AE reporting among HVTN702 trial participants in South Africa. Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) were diagnosed POC at eThekwini clinic and in a central laboratory at Verulam/Isipingo clinics. All clinics used POC assays for Trichomonas vaginalis (TV) testing.

Results: Among 959 women (median age, 23 [interquartile range, 21-26] years), median days (95% confidence interval [95%CI]) to NG/CT treatment initiation and NG/CT-AE reporting were 0.20 (.16-.25) and 0.24 (.19-.27) at eThekwini versus 14.22 (14.12-15.09) and 15.12 (13.22-21.24) at Verulam/Isipingo (all P < .001). Median days (95%CI) to TV treatment initiation and TV-AE reporting were 0.17 (.12-.27) and 0.25 (.20-.99) at eThekwini versus 0.18 (.15-.2) and 0.24 (.15-.99) at Verulam/Isipingo (all P > .05). Cox regression analysis revealed that NG/CT treatment initiation (adjusted hazard ratio [aHR], 39.62 [95%CI, 15.13-103.74]) and NG/CT-AE reporting (aHR, 3.38 [95%CI, 2.23-5.13]) occurred faster at eThekwini versus Verulam/Isipingo, while times to TV treatment initiation (aHR, 0.93 [95%CI, .59-1.48]) and TV-AE reporting (aHR, 1.38 [95%CI, .86-2.21]) were similar.

Conclusions: POC testing led to prompt STI management with potential therapeutic and prevention benefits, highlighting its utility as a diagnostic tool in resource-limited settings.

Keywords: adverse event reporting; central laboratory–based testing; point-of-care testing; sexually transmitted infections; treatment initiation.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Chlamydia Infections* / diagnosis
  • Chlamydia Infections* / drug therapy
  • Chlamydia Infections* / epidemiology
  • Chlamydia trachomatis
  • Female
  • Gonorrhea* / diagnosis
  • Gonorrhea* / drug therapy
  • Gonorrhea* / epidemiology
  • HIV
  • HIV Infections* / diagnosis
  • HIV Infections* / drug therapy
  • HIV Infections* / epidemiology
  • Humans
  • Neisseria gonorrhoeae
  • Point-of-Care Testing
  • Sexually Transmitted Diseases* / diagnosis
  • Sexually Transmitted Diseases* / drug therapy
  • Sexually Transmitted Diseases* / epidemiology
  • South Africa / epidemiology
  • Trichomonas vaginalis*
  • Vaccines*
  • Young Adult

Substances

  • Vaccines