An optimized diagnostic screening tool and GeneXpert pooling algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae to reduce cost of molecular STI screening in resource-limited settings Público

Abstract

Background: Sexually transmitted infections (STIs) such as chlamydia (CT) and gonorrhea (NG) have been shown to increase the risk of heterosexual HIV-1 transmission as well as other reproductive tract comorbidities such as pelvic inflammatory disease, infertility, and pregnancy complications. In women, CT and NG are often asymptomatic and undetected by syndromic management. Molecular testing for these STIs is highly sensitive, but time and cost restraints preclude implementation of these technologies in resource-limited settings.

Methods: Pooling samples for simultaneous testing in GeneXpert cartridges is one strategy for reducing the cost per individual tested. The current study describes a pooling strategy based on identification of social and demographic factors associated with CT/NG prevalence in a high-risk cohort of HIV-uninfected Zambian female sex workers or single mothers conducted from 2016-2019.

Results: Factors significantly (p<0.05) associated with CT/NG via logistic regression included city, younger age, lower education, Trichomonas vaginalis, bacterial vaginosis, and syphilis infection. The cost per test with unguided pooling was $12.96. However, the cost per test can be further reduced to as low as $9.43 per sample by strategically pooling women with similar CT/NG factors together and testing those at highest risk individually.

Conclusions: The checklist tool developed and pooling approach described can be used in a variety of different of treatment algorithms in order to strategically manage limited resources, while also maximizing the number of women receiving STI screening and treatment.

Table of Contents

Abstract

Acknowledgements

An optimized diagnostic screening tool and GeneXpert pooling

algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae

to reduce cost of molecular STI screening in resource-limited settings.......... 1

Introduction.............................................................................. 2

Materials and Methods................................................................. 4

Results.................................................................................... 9

Discussion............................................................................... 15

Acknowledgements..................................................................... 17

Table 1: Prevalence of Signs and Symptoms by CT and/or NG

Status and City............................................................................ 18

Table 2: Prevalence of Signs and Symptoms Combined by

CT/NG Status............................................................................. 19

Table 3: Prevalence of Lab Results by CT and/or NG

Status and City............................................................................ 20

Table 4: Prevalence of Demographic Factors and Risk Behaviors

by CT and/or NG Status and City..................................................... 21

Table 5: Logistic Regression Model of Factors Associated with

Either CT and/or NG.................................................................... 22

Figure 1: Checklist for Optimized CT/NG GeneXpert Pooling................ 23

Figure 2: Distribution of Checklist Scores with CT/NG Result

Reported (N=496).......................................................................... 24

Table 6: Bivariate Logistic Regression Model of Composite Score

Category and Either CT and/or NG (n=496)............................................ 25

Figure 3: Pooling Low and Mid Risk Group Samples Results in

Cost Savings per Sample................................................................... 26

Figure 4: Cost Savings Over Time is Greatest with Score-Guided

Pooling Strategy............................................................................. 27

References........................................................................................ 28

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Palavra-chave	Global Health Diagnosis Chlamydia Algorithms Gonorrhea Sexually Transmitted Diseases
Committee Chair / Thesis Advisor	Susan Allen, Emory University
Committee Members	Kristin Wall, Emory University Eric Hunter, Emory University

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