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. 2023 Dec;73(6S):S67-S72.
doi: 10.1016/j.jadohealth.2023.09.004.

Comparing the Integration of Syndromic versus Etiological Management of Sexually Transmitted Infections Into HIV Pre-Exposure Prophylaxis Services for Adolescent Girls and Young Women, in South Africa

Saiqa Mullick  1 , Laura Ashleigh Cox  2 , Catherine E Martin  2 , Zukiswa Fipaza  2 , Sydney Ncube  2
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Free article

Comparing the Integration of Syndromic versus Etiological Management of Sexually Transmitted Infections Into HIV Pre-Exposure Prophylaxis Services for Adolescent Girls and Young Women, in South Africa

Saiqa Mullick et al. J Adolesc Health. 2023 Dec.
Free article

Abstract

South Africa has a high incidence of human immunodeficiency virus and sexually transmitted infections (STIs), particularly among adolescent girls and young women. National and global guidelines recommend varied strategies for integrating STI and pre-exposure prophylaxis (PrEP) services.

Purpose: This paper describes the implementation of a syndromic compared to an etiological approach to STI integration within PrEP services in South Africa.

Methods: We analysed program data from eight fixed and four mobile clinics to describe a cascade of STI care and integration of syndromic management among clients accessing PrEP services. Diagnostic testing was conducted in a subset of clients to determine the prevalence of STIs and estimate the burden of disease missed using a syndromic approach.

Results: Between December 2018 and December 2021, 22,505 clients sought services and a high proportion (92.9%) was screened for STI symptoms. Of these, 9% of females and 3% of males had symptoms and 89.5% had recorded treatment. In a subset of PrEP clients (406 females, 70 males) screened through laboratory testing, chlamydia was identified in 25.7% of female and 20.0% of male samples, gonorrhea in 14.1% of female and 18.6% of male samples, and syphilis in 2.3% of female and 1.4% of male samples. Highest prevalence was found among females aged 18-20 years.

Discussion: Syndromic STI screening and management can be integrated into routine PrEP service delivery and can identify symptomatic STIs, but misses asymptomatic infections. PrEP clients have a high prevalence of treatable STIs. Etiologic approaches can identify more infections than syndromic screening, but cheap point-of-care tests are needed.

Keywords: Adolescent girls and young women; HIV prevention; PrEP; Pre-exposure prophylaxis; STI; Sexually transmitted infections; Syndromic screening.

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