Evaluation of screening for Chlamydia trachomatis among young women in primary health care services in Manaus, Amazonas State, Brazil

Abstract

Screening for Chlamydia trachomatis is not routinely offered to young asymptomatic women in Brazil. This study evaluated the performance, usefulness, and operational suitability of the Digene Hybrid Capture II (HCII) CT-ID DNA-test as an opportunistic screening tool to detect C. trachomatis in the public health system in Manaus, Amazonas State. Women aged 14-25 years who attended primary health care services were interviewed and one cervical specimen was collected during cytological screening. The HCII CT test was evaluated for its ability to detect the presence of C. trachomatis and against real-time PCR (q-PCR) in a subset of samples. Operational performance was assessed through interviews with providers and patients. Overall, 1,187 women were screened, and 1,169 had a HCII CT-ID test result (292 of these were also tested by q-PCR). Of those, 13.1% (n = 153) were positive. The sensitivity, specificity, positive and negative predictive values of HCII CT were 72.3% (95%CI: 65.4-78.6), 91.3% (95%CI: 84.1-95.9), 93.8% (95%CI: 88.5-97.1), and 64.4% (95%CI: 56.0-72.1), respectively. Sample collection caused discomfort in 19.7% of women. Among health professionals (n = 52), the main barriers reported included positive cases who did not return for results (56.4%), unwillingness to screen without an appointment (45.1%), and increase in their workload (38.8%). HCII CT-ID identified a high proportion of C. trachomatis cases among young women in Manaus. However, its moderate sensitivity limits its use as an opportunistic screening tool in primary health care settings in Manaus. Screening was well accepted although the barriers we identified, especially among health professionals, challenge screening detection and treatment efforts.

High prevalence of Chlamydia trachomatis in pregnant women attended at Primary Health Care services in Amazon, Brazil

“…In Brazil, the HC test has already been approved by the National Agency of Sanitary Surveillance ( Agência Nacional de Vigilância Sanitária - ANVISA), and the Unified Health System ( Sistema Único de Saúde - SUS) and included in the list of paid procedures. However, studies have shown that the sensitivity of the HC test ranges from 66.7% to 72.3% when compared to PCR, being inappropriate for CT screening due to this moderate sensitivity 31 .…”

Prevalence of human papillomavirus, Chlamydia trachomatis, and Trichomonas vaginalis infections in Amazonian women with normal and abnormal cytology

“…In a study in Manaus involving women with infertility correlated with CT, de Lima Freitas et al (2011) observed a prevalence of 52.8%, which was much higher than that described by Fernandes et al (2014), who reported a prevalence similar to our results (10.9%) among women with a history of infertility, who had undergone assisted reproduction techniques. Another important study carried out by Neves et al (2016) on asymptomatic women aged 14-25 years who used public health services in Manaus showed a prevalence of 13.1% for CT infections, whereas in women aged 20-25 years this prevalence was 10.8%, as determined by the Digene Hybrid Capture II Test (HCII CT-ID). Our results corroborate the prevalence range found in the rest of Brazil (9.1-14.3%) (de Paula et al, 2007;Oliveira et al, 2009;Benzaken et al, 2010;Piazzetta et al, 2011;Garcês et al, 2013).…”

Prevalência de infecção por Chlamydia trachomatis na população feminina brasileira: um artigo de revisão

“…Segundo Neves et al (2016), diversos métodos moleculares podem ser utilizados para diagnóstico da CT como PCR multiplex (reação em cadeia da polimerase), para detecção do DNA da CT, sendo altamente sensível e específico.…”