Call to action for health systems integration of point-of-care testing to mitigate the transmission and burden of sexually transmitted infections

Abstract

Objectives: In 2016, WHO estimated 376 million new cases of the four main curable STIs: gonorrhoea, chlamydia, trichomoniasis and syphilis. Further, an estimated 290 million women are infected with human papillomavirus. STIs may lead to severe reproductive health sequelae. Low-income and middle-income countries carry the highest global burden of STIs. A large proportion of urogenital and the vast majority of extragenital non-viral STI cases are asymptomatic. Screening key populations and early and accurate diagnosis are important to provide correct treatment and to control the spread of STIs. This article paints a picture of the state of technology of STI point-of-care testing (POCT) and its implications for health system integration.

Methods: The material for the STI POCT landscape was gathered from publicly available information, published and unpublished reports and prospectuses, and interviews with developers and manufacturers.

Results: The development of STI POCT is moving rapidly, and there are much more tests in the pipeline than in 2014, when the first STI POCT landscape analysis was published on the website of WHO. Several of the available tests need to be evaluated independently both in the laboratory and, of particular importance, in different points of care.

Conclusion: This article reiterates the importance of accurate, rapid and affordable POCT to reach universal health coverage. While highlighting the rapid technical advances in this area, we argue that insufficient attention is being paid to health systems capacity and conditions to ensure the swift and rapid integration of current and future STI POCT. Unless the complexity of health systems, including context, institutions, adoption systems and problem perception, are recognised and mapped, simplistic approaches to policy design and programme implementation will result in poor realisation of intended outcomes and impact.

Keywords: point of care; public health; resource-limited settings; testing.

Figure 1

Roadmap to advance point-of-care testing for the control and prevention of STIs (adapted from Toskin et al 10).

Figure 2

Landscape for HIV/syphilis POCTs. TP, Treponema pallidum subspecies pallidum.

Figure 3

Landscape for NG, CT, TV and HPV point-of-care testing. CT, Chlamydia trachomatis; HPV, human papillomavirus; NG, Neisseria gonorrhoeae; TV, Trichomonas vaginalis; MSTI, multi-STI; CPA, cross priming amplification;.

Figure 4

Social construction perspective on health policy and systems (adapted from Sheikh et al).[w3].