“It was difficult to offer same day results”: evaluation of community-based point-of-care testing for sexually transmitted infections among youth using the GeneXpert platform in Zimbabwe

Abstract

Background Point-of-care testing for sexually transmitted infections (STIs) may improve diagnosis and treatment of STIs in low- and middle-income counties. We explored the facilitators and barriers to point-of-care testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoea (NG) for youth in community-based settings in Zimbabwe. Methods This study was nested within a cluster randomised trial of community-based delivery of integrated HIV and sexual and reproductive health services for youth aged 16 to 24 years. On-site CT/NG testing on urine samples using the Xpert® CT/NG test was piloted in four intervention clusters, with testing performed by service providers. On-site testing was defined as sample processing on the same day and site as sample collection. Outcomes included proportion of tests processed on-site, time between sample collection and collection of results, and proportion of clients receiving treatment. In-depth interviews were conducted with nine service providers and three staff members providing study co-ordination or laboratory support to explore facilitators and barriers to providing on-site CT/NG testing. Results Of 847 Xpert tests, 296 (35.0%) were performed on-site. Of these, 61 (20.6%) were positive for CT/NG; one (1.6%) received same day aetiological treatment; 33 (54.1%) presented later for treatment; and 5 (8.2%) were treated as a part of syndromic management. There was no difference in the proportion of clients who were treated whether their sample was processed on or off-site (64% (39/61) vs 60% (66/110); p = 0.61). The median (IQR) number of days between sample collection and collection of positive results was 14 (7–35) and 14 (7–52.5) for samples processed on and off-site, respectively, The interviews revealed four themes related to the provision of on-site testing associated with the i) diagnostic device ii) environment, iii) provider, and iv) clients. Some of the specific barriers identified included insufficient testing capacity, inadequate space, as well as reluctance of clients to wait for their results. Conclusions In addition to research to optimise the implementation of point-of-care tests for STIs in resource-limited settings, the development of new platforms to reduce analytic time will be necessary to scale up STI testing and reduce the attrition between testing and treatment. Trial registration Registered in clinical trials.gov (NCT03719521).

Facilitators and barriers to in vitro diagnostics implementation in resource-limited settings: A scoping review

“…Finally, 16 articles remained for data extraction and analysis. The reasons for exclusion following the full-text screening were the following: five were review papers 24,38,39,40,41 ; two were conducted in high-income countries 42,43 ; one article focused on a POC test not included in the WHO EDL 44 ; and one reported on a POC test for health facilities with laboratories 45 (Figure 1).…”

“…The study result indicated fewer (37%) reports on the facilitators to POC diagnostics 46,47,49,50,51,54 than barriers (63%). 4,27,45,47,48,52,53,56,57,58 We discovered limited literature reporting on both facilitators and barriers to POC diagnostics test implementation in the LMICs, especially concerning general POC diagnostic tests for using health facilities without laboratories.…”

Facilitators and barriers to point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review

“…However, as the search was limited to English language articles only, potentially relevant studies may have been missed, which could have introduced bias into our review. Furthermore, the search was performed on 5th June 2020, and so more recent relevant studies will have been published since, of which some are known [ 118 – 120 ]. However, given the high number of included studies, and that saturation was reached, an updated search was not felt to be warranted.…”

Preferences for the management of sexually transmitted infections in the South African health system: A discrete choice experiment

“…In a South African study, it was estimated that patients had to wait for a mean of nearly 5 hours for STI POC diagnostic testing using GeneXpert CT/NG assay which is unlikely to be acceptable to healthcare users [20]. The challenges of using GeneXpert CT/NG as an STI POC diagnostic tool was further highlighted by a recent study in Zimbabwe in which Youth were unwilling to wait 90 minutes for their results [30].…”

“…Even with a diagnostic approach, challenges with return for results and treatment provision exist. An estimated 36 – 40% of positive cases of STIs did not receive their results or treatment in one study implementing point of care STI testing in Zimbabwe [12]. Challenges with partner notification and treatment among young people also hinder STI control [13].…”