A systematic review and meta-analysis of studies evaluating the performance and operational characteristics of dual point-of-care tests for HIV and syphilis

Gliddon, Harriet D.; Peeling, Rosanna W.; Kamb, Mary L.; Toskin, Igor; Wi, Teodora; Taylor, Melanie

doi:10.1136/sextrans-2016-053069

Cited by 68 publications

(77 citation statements)

References 51 publications

(70 reference statements)

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“…The dual RDT was more cost effective than single RDTs and prevented more adverse outcomes of pregnancy. Qualitative data indicated that dual tests were acceptable in terms of turnaround time, cost and a single finger prick .…”

Section: Resultsmentioning

confidence: 99%

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Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

Ndowa²,

et al. 2019

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Introduction Sexually transmitted infections (STIs) remain prevalent and are increasing in several populations. Appropriate STI diagnosis is crucial to prevent the transmission and sequelae of untreated infection. We reviewed the diagnostic accuracy of syndromic case management and existing point‐of‐care tests (POCTs), including those in the pipeline, to diagnose STIs in resource‐constrained settings. Methods We prioritized updating the systematic review and meta‐analysis of the diagnostic accuracy of vaginal discharge from 2001 to 2015 to include studies until 2018. We calculated the absolute effects of different vaginal flowcharts and the diagnostic performance of POCTs on important outcomes. We searched the peer‐reviewed literature for previously conducted systematic reviews and articles from 1990 to 2018 on the diagnostic accuracy of syndromic management of vaginal and urethral discharge, genital ulcer and anorectal infections. We conducted literature reviews from 2000 to 2018 on the existing POCTs and those in the pipeline. Results and discussions The diagnostic accuracy of urethral discharge and genital ulcer disease syndromes is relatively adequate. Asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections limit the use of vaginal discharge and anorectal syndromes. The pooled diagnostic accuracy of vaginal syndromic case management for CT/NG is low, resulting in high numbers of overtreatment and missed treatment. The absolute effect of POCTs was reduced overtreatment and missed treatment. Findings of the reviews on syndromic case management underscored the need for low‐cost and accurate POCTs for the identification, first, of CT/NG, and, second, of Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) and NG and MG resistance/susceptibility testing. Near‐patient POCT molecular assays for CT/NG/TV are commercially available. The prices of these POCTs remain the barrier for uptake in resource‐constrained settings. This is driving the development of lower cost solutions. Conclusions The WHO syndromic case management guidelines should be updated to raise the quality of STI management through the integration of laboratory tests. STI screening strategies are needed to address asymptomatic STIs. POCTs that are accurate, rapid, simple and affordable are urgently needed in resource‐constrained settings to support the uptake of aetiological diagnosis and treatment.

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Section: Resultsmentioning

confidence: 99%

“…A review by Gliddon et al. showed that the diagnostic accuracy of the HIV component of the dual test ranged from 94% to 99% sensitivity and from 92% to 100% specificity. The syphilis diagnostic accuracy ranged from 47% to 96% sensitivity and 90% to 100% specificity.…”

Section: Resultsmentioning

confidence: 99%

Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

Ndowa²,

et al. 2019

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“…Countries need to harness the architecture provided by HIV PMTCT programmes to screen women for both infections using a single drop of blood in a single visit to a health care facility. Dual rapid HIV-syphilis RDTs with acceptable performance are now available 36 and the WHO, as well as many countries, has adopted these HIV and/or syphilis RDTs into their national guidelines 31,37 .…”

Section: Malariamentioning

confidence: 99%

REASSURED diagnostics to inform disease control strategies, strengthen health systems and improve patient outcomes

et al. 2018

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“…Additionally, dual syphilis/HIV rapid tests are available to screen for HIV and treponemal antibodies using a single lateral flow immunochromatographic strip. These are an increasingly important tool in the global elimination of MTCT of HIV and syphilis in settings in which laboratory capacity is limited 159 .…”

Section: Diagnosis Screening and Preventionmentioning

confidence: 99%

Syphilis

Peeling

Mabey

Kamb

et al. 2017

Nat Rev Dis Primers

484

387

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Treponema pallidum subspecies pallidum (T. pallidum) causes syphilis via sexual exposure or vertical transmission during pregnancy. T. pallidum is renowned for its invasiveness and immune-evasiveness; its clinical manifestations result from local inflammatory responses to replicating spirochetes and often imitate those of other diseases. The spirochete has a long latent period during which patients have no signs or symptoms, but can remain infectious. Despite the availability of simple diagnostic tests and the effectiveness of treatment with a single dose of long-acting penicillin, syphilis is re-emerging as a global public health problem, particularly among men who have sex with men (MSM) in high-income and middle-income countries. Syphilis also causes several hundred thousand stillbirths and neonatal deaths every year in developing nations. Although several low-income countries have achieved WHO targets for the elimination of congenital syphilis, an alarming increase of syphilis in HIV-infected MSM serves as a strong reminder of the tenacity of T. pallidum as a pathogen. Strong advocacy and community involvement is needed to ensure that syphilis is given high priority on the global health agenda. More investment in research is needed on the interaction between HIV and syphilis in MSM, as well as into improved diagnostics, a better test of cure, intensified public health measures and, ultimately, a vaccine.

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A systematic review and meta-analysis of studies evaluating the performance and operational characteristics of dual point-of-care tests for HIV and syphilis

Cited by 68 publications

References 51 publications

Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

REASSURED diagnostics to inform disease control strategies, strengthen health systems and improve patient outcomes

Syphilis

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