Performance of point-of-care tests for the detection of chlamydia trachomatis infections: A systematic review and meta-analysis

Zhou, Ying; Jiang, Tingting; Li, Jing; Yin, Yue-Ping; Chen, Xiang-Sheng

doi:10.1016/j.eclinm.2021.100961

Cited by 8 publications

(7 citation statements)

References 70 publications

(114 reference statements)

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“…Our results are in accordance with a meta-analysis conducted by Zhou et al 7 on POCTs (NAATs or antigen-detection tests) for CT screening that excluded POCT performance with SS. Our results complement a meta-analysis comparing SS with clinician sampling for CT/GC conducted by Lunny et al 8 years ago.…”

Section: Discussionsupporting

confidence: 92%

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Self-sampling strategies (with/without digital innovations) in populations at risk ofChlamydia trachomatisandNeisseria gonorrhoeae: a systematic review and meta-analyses

et al. 2023

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BackgroundChlamydia trachomatis(CT) andNeisseria gonorrhoeae(GC) resulted in over 200 million new sexually transmitted infections last year. Self-sampling strategies alone or combined with digital innovations (ie, online, mobile or computing technologies supporting self-sampling) could improve screening methods. Evidence on all outcomes has not yet been synthesised, so we conducted a systematic review and meta-analysis to address this limitation.MethodsWe searched three databases (period: 1 January 2000–6 January 2023) for reports on self-sampling for CT/GC testing. Outcomes considered for inclusion were: accuracy, feasibility, patient-centred and impact (ie, changes in linkage to care, first-time testers, uptake, turnaround time or referrals attributable to self-sampling).We used bivariate regression models to meta-analyse accuracy measures from self-sampled CT/GC tests and obtain pooled sensitivity/specificity estimates. We assessed quality with Cochrane Risk of Bias Tool-2, Newcastle–Ottawa Scale and Quality Assessment of Diagnostic Accuracy Studies-2 tool.ResultsWe summarised results from 45 studies reporting self-sampling alone (73.3%; 33 of 45) or combined with digital innovations (26.7%; 12 of 45) conducted in 10 high-income (HICs; n=34) and 8 low/middle-income countries (LMICs; n=11). 95.6% (43 of 45) were observational, while 4.4% (2 of 45) were randomised clinical trials.We noted that pooled sensitivity (n=13) for CT/GC was higher in extragenital self-sampling (>91.6% (86.0%–95.1%)) than in vaginal self-sampling (79.6% (62.1%–90.3%)), while pooled specificity remained high (>99.0% (98.2%–99.5%)).Participants found self-sampling highly acceptable (80.0%–100.0%; n=24), but preference varied (23.1%–83.0%; n=16).Self-sampling reached 51.0%–70.0% (n=3) of first-time testers and resulted in 89.0%–100.0% (n=3) linkages to care. Digital innovations led to 65.0%–92% engagement and 43.8%–57.1% kit return rates (n=3).Quality of studies varied.DiscussionSelf-sampling had mixed sensitivity, reached first-time testers and was accepted with high linkages to care. We recommend self-sampling for CT/GC in HICs but additional evaluations in LMICs. Digital innovations impacted engagement and may reduce disease burden in hard-to-reach populations.PROSPERO registration numberCRD42021262950.

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Section: Discussionsupporting

confidence: 92%

“…A systematic review reported higher accuracy of nucleic acid amplification tests (NAATs) for CT detection compared with antigen-based tests but failed to evaluate SS 7. A systematic review by Lunny et al , published 8 years ago, reported comparable accuracy of self-obtained samples with clinician-obtained samples (n=6100 paired samples) 8.…”

Section: Introductionmentioning

confidence: 99%

Self-sampling strategies (with/without digital innovations) in populations at risk ofChlamydia trachomatisandNeisseria gonorrhoeae: a systematic review and meta-analyses

et al. 2023

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“…The nature of the populations tested, small sample numbers, and the diverse diagnostic techniques further influence results (66). Furthermore, testing techniques vary substantially and approaches, such as nucleic acid amplification tests, which has been proven to be more sensitive and specific, compared to enzyme immunoassay tests, may require transport to specialize laboratory, as well as specialized equipment and staff, delaying the availability of results for rapid management choices in certain regions (67). As a result, in some cases, the most accurate test may not be the approach eventually used.…”

Section: Figurementioning

confidence: 99%

The association between adverse pregnancy outcomes and non-viral genital pathogens among women living in sub-Saharan Africa: a systematic review

Gamberini,

Juliana,

de Brouwer

et al. 2023

Front. Reprod. Health

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Adverse pregnancy outcomes are the main causes of maternal and neonatal morbidity and mortality, including long-term physical and psychological sequelae. These events are common in low- and middle-income countries, particularly in Sub Saharan Africa, despite national efforts. Maternal infections can cause complications at any stage of pregnancy and contribute to adverse outcomes. Among infections, those of the genital tract are a major public health concern worldwide, due to limited availability of prevention, diagnosis and treatment approaches. This applies even to treatable infections and holds true especially in Sub-Saharan Africa. As late as 2017, the region accounted for 40% of all reported treatable non-viral genital pathogens worldwide, many of which have been independently associated with various adverse pregnancy outcomes, and that include Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Treponema pallidum. Two databases (PubMed and Embase) were examined to identify eligible studies published up to October 2022. This study reviewed findings on the association between infections by treatable non-viral genital pathogens during pregnancy and adverse pregnancy outcomes among women living in Sub-Saharan Africa. Articles' title and abstract were screened at first using keywords as “sexually transmitted infections”, “non-viral”, “adverse pregnancy outcome”, “Africa”, “sub-Saharan Africa”, “pregnant women”, “pregnancy”, and “pregnancy outcome”. Subsequently, according to the eligibility criteria, potential articles were read in full. Results showed that higher risk of preterm birth is associated with Treponema pallidum, Chlamydia trachomatis and Candida albicans infections. Additionally, rates of stillbirth, neonatal death, low birth weight and intrauterine growth restriction are also associated with Treponema pallidum infection. A better insight on the burden of non-viral genital pathogens and their effect on pregnancy is needed to inform antenatal care guidelines and screening programs, to guide the development of innovative diagnostic tools and other strategies to minimize transmission, and to prevent short- and long-term complications for mothers and children.

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“…The efforts in PICTs to improve testing for and surveillance of HIV and syphilis have unfortunately not been replicated for C. trachomatis and N. gonorrhoeae. This is due to several reasons, including a lack of accurate, affordable tests [72]. Neither C. trachomatis nor N. gonorrhoeae are routinely tested for or reported in most PICTs.…”

Section: Historical and Current Approaches To Sti Testing In Pictsmentioning

confidence: 99%

Chlamydial and gonorrheal neglected sexually transmitted diseases among Pacific Islanders of the Western Pacific Region—A narrative review and call to action

et al. 2023

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The Pacific Island countries of the Western Pacific Region have some of the highest rates of sexually transmitted Chlamydia trachomatis and Neisseria gonorrhoeae infections in the world. Despite this, there are few research studies that include Pacific Islanders. We conducted a narrative review of original research and surveys, including World Health Organization and Pacific Community reports, to determine the prevalence, management, and treatment of C. trachomatis and N. gonorrhoeae compared to HIV and syphilis from 1980 to 2022. Available epidemiologic data on C. trachomatis and N. gonorrhoeae indicated an extremely high prevalence—approximately 30% and 13%, respectively—among Pacific Islanders during this timeframe. These neglected sexually transmitted infections represent a significant burden and health disparity. Robust epidemiologic research is needed to identify modifiable risk factors for designing interventions and control strategies. Appropriate policies along with regional and international advocacy and aid are required to improve reproductive health among these vulnerable, understudied populations to avert preventable infections and sequelae.

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Performance of point-of-care tests for the detection of chlamydia trachomatis infections: A systematic review and meta-analysis

Cited by 8 publications

References 70 publications

Self-sampling strategies (with/without digital innovations) in populations at risk ofChlamydia trachomatisandNeisseria gonorrhoeae: a systematic review and meta-analyses

Self-sampling strategies (with/without digital innovations) in populations at risk ofChlamydia trachomatisandNeisseria gonorrhoeae: a systematic review and meta-analyses

The association between adverse pregnancy outcomes and non-viral genital pathogens among women living in sub-Saharan Africa: a systematic review

Chlamydial and gonorrheal neglected sexually transmitted diseases among Pacific Islanders of the Western Pacific Region—A narrative review and call to action

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