Sexually transmitted infections · 2026
From syndromic management to diagnostic-led management: a report from an expert meeting on introducing sexually transmitted infection testing in low-resource settings.
СтатьяНазвание и аннотация: Перевод в очереди
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Manguro Griffins O, Ray Jill, Schocken Celina, Were Daniel K, Omballa Victor O, Johnson Cheryl C, Dziva Chikwari Chido, Footman Alison, Newman Lori M, Peters Remco P H
Аннотация
INTRODUCTION: Syndromic management remains the primary approach for identifying and treating sexually transmitted infections (STIs) in low-resource settings. While faster and inexpensive, it leads to overtreatment, undertreatment and missed opportunities for surveillance. Recent advances in point-of-care (POC) diagnostic technologies for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and other STIs present new opportunities to improve STI management.
METHODS: In September 2024, the Gates Foundation convened a 3-day expert meeting in Nairobi, Kenya, bringing together 44 global and national experts in STI diagnostic development, implementation research, policy, regulatory affairs and clinical practice. The objective was to identify priorities and strategies for advancing the introduction and scale-up of STI POC testing in low-resource settings with a focus on sub-Saharan Africa.
RESULTS: Participants identified opportunities and barriers for introducing STI POC testing at various levels: individual client, health service delivery, national and global. At the individual client level, recommendations to optimise testing uptake included identifying and piloting strategies to improve knowledge about STIs and testing as well as addressing barriers to testing. At the health service delivery level, recommendations were to optimise clinical workflows, consider testing outside traditional health facilities (including private pharmacies), encourage self-collection and improve partner notification. At the national level, recommendations included updating treatment guidelines to incorporate diagnostic testing, strengthening laboratory quality assurance for STI tests and advocating for the public health importance of STIs, which remain underprioritised. This also involves building political commitment. At the global level, recommendations included harmonising regulatory requirements across regions, leveraging WHO prequalification processes, and expanding manufacturing capacity through technology transfer.
CONCLUSIONS: Effective introduction of STI POC diagnostics in low-resource settings will require coordinated efforts across global and national levels. Successful introduction, while ensuring equitable access, will accelerate access to quality STI care, reduce antimicrobial resistance and improve STI control outcomes.
METHODS: In September 2024, the Gates Foundation convened a 3-day expert meeting in Nairobi, Kenya, bringing together 44 global and national experts in STI diagnostic development, implementation research, policy, regulatory affairs and clinical practice. The objective was to identify priorities and strategies for advancing the introduction and scale-up of STI POC testing in low-resource settings with a focus on sub-Saharan Africa.
RESULTS: Participants identified opportunities and barriers for introducing STI POC testing at various levels: individual client, health service delivery, national and global. At the individual client level, recommendations to optimise testing uptake included identifying and piloting strategies to improve knowledge about STIs and testing as well as addressing barriers to testing. At the health service delivery level, recommendations were to optimise clinical workflows, consider testing outside traditional health facilities (including private pharmacies), encourage self-collection and improve partner notification. At the national level, recommendations included updating treatment guidelines to incorporate diagnostic testing, strengthening laboratory quality assurance for STI tests and advocating for the public health importance of STIs, which remain underprioritised. This also involves building political commitment. At the global level, recommendations included harmonising regulatory requirements across regions, leveraging WHO prequalification processes, and expanding manufacturing capacity through technology transfer.
CONCLUSIONS: Effective introduction of STI POC diagnostics in low-resource settings will require coordinated efforts across global and national levels. Successful introduction, while ensuring equitable access, will accelerate access to quality STI care, reduce antimicrobial resistance and improve STI control outcomes.