A novel point-of-care testing strategy for sexually transmitted infections among pregnant women in high-burden settings: results of a feasibility study in Papua New Guinea.
Sexually transmitted and genital infections in pregnancy are associated with an increased risk of adverse maternal and neonatal health outcomes. High prevalences of sexually transmitted infections have been identified among antenatal attenders in Papua New Guinea. Papua New Guinea has amongst the highest neonatal mortality rates worldwide, with preterm birth and low birth weight major contributors to neonatal mortality. The overall aim of our study was to determine if a novel point-of-care testing and treatment strategy for the sexually transmitted and genital infections Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Bacterial vaginosis (BV) in pregnancy is feasible in the high-burden, low-income setting of Papua New Guinea.



Women attending their first antenatal clinic visit were invited to participate. CT/NG and TV were tested using the GeneXpert platform (Cepheid, USA), and BV tested using BVBlue (Gryphus Diagnostics, USA). Participants received same-day test results and antibiotic treatment as indicated. Routine antenatal care including HIV and syphilis screening were provided.



Point-of-care testing was provided to 125/222 (56 %) of women attending routine antenatal care during the three-month study period. Among the 125 women enrolled, the prevalence of CT was 20.0 %; NG, 11.2 %; TV, 37.6 %; and BV, 17.6 %. Over half (67/125, 53.6 %) of women had one or more of these infections. Most women were asymptomatic (71.6 %; 47/67). Women aged 24 years and under were more likely to have one or more STI compared with older women (odds ratio 2.38; 95 % CI: 1.09, 5.21). Most women with an STI received treatment on the same day (83.6 %; 56/67). HIV prevalence was 1.6 % and active syphilis 4.0 %.



Point-of-care STI testing and treatment using a combination of novel, newly-available assays was feasible during routine antenatal care in this setting. This strategy has not previously been evaluated in any setting and offers the potential to transform STI management in pregnancy and to prevent their associated adverse health outcomes.
The Kirby Institute, University of New South Wales, Sydney, Australia. sbadman@kirby.unsw.edu.au.
Steven G
SG
Badman
The Kirby Institute, University of New South Wales, Sydney, Australia.
Lisa M
LM
Vallely
Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
Pamela
P
Toliman
Department of Obstetrics & Gynaecology, Alotau General Hospital, Milne Bay Province, Alotau, Papua New Guinea.
Grace
G
Kariwiga
Alotau Urban Clinic, Alotau, Milne Bay Province, Papua New Guinea.
Bomesina
B
Lote
Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
William
W
Pomat
University of Technology, Sydney, Australia.
Caroline
C
Holmer
The Kirby Institute, University of New South Wales, Sydney, Australia.
Rebecca
R
Guy
The Burnet Institute, Melbourne, Australia.|Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
Stanley
S
Luchters
The Burnet Institute, Melbourne, Australia.
Chris
C
Morgan
Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia.|Department of Obstetrics and Gynaecology, University of Melbourne, Murdoch Children's Research Institute, Parkville, VIC, Australia.
Suzanne M
SM
Garland
Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia.
Sepehr
S
Tabrizi
University of Queensland, Herston, QLD, Australia.
David
D
Whiley
Department of Medicine, University of Melbourne, Melbourne, Australia.
Stephen J
SJ
Rogerson
Department of Obstetrics & Gynaecology, School of Medicine and Health Sciences, University of Papua New Guinea, National Capital District, Papua New Guinea.
Glen
G
Mola
The Kirby Institute, University of New South Wales, Sydney, Australia.
Handan
H
Wand
The Kirby Institute, University of New South Wales, Sydney, Australia.|Sydney Sexual Health Centre, Sydney, Australia.
Basil
B
Donovan
The Kirby Institute, University of New South Wales, Sydney, Australia.
Louise
L
Causer
The Kirby Institute, University of New South Wales, Sydney, Australia.
John
J
Kaldor
The Kirby Institute, University of New South Wales, Sydney, Australia.
Andrew
A
Vallely
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000554:Ambulatory Care Facilities; D058345:Asymptomatic Infections / Q000453:epidemiology; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology; D002692:Chlamydia trachomatis; D005240:Feasibility Studies; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D009344:Neisseria gonorrhoeae; D016017:Odds Ratio; D010219:Papua New Guinea / Q000453:epidemiology; D000067716:Point-of-Care Testing; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000453:epidemiology; D011295:Prenatal Care; D015995:Prevalence; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology; D013587:Syphilis / Q000175:diagnosis / Q000453:epidemiology; D014245:Trichomonas Infections / Q000175:diagnosis* / Q000453:epidemiology; D014246:Trichomonas vaginalis; D016585:Vaginosis, Bacterial / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult
Antenatal; Genexpert; Low-middle-income country; Molecular testing; Point-of-care; Pregnancy outcome; STIs; Syndromic management