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Symposium 2: Rapid tests as tools to transform policy, strengthen health systems and save lives (sponsored by WHO/TDR and the London school of hygiene and tropical medicine)
S2.4 New technologies to support STI screening and syndromic management in resource-limited settings
  1. R Peeling
  1. London School of Health and Tropical Medicine, London, UK

Abstract

Background High quality tests for detection of STIs are available but they are neither affordable nor available to patients in resource-limited settings. For patients presenting with STI symptoms, WHO recommends the use of syndromic management in settings where laboratory services are not available. As most STI patients tend to have few or no symptoms, tests to screen for STIs is important for guiding treatment and prevention of onward transmission. However, in resource-limited settings, patients often have to travel long distances to reach a clinic with STI services, and many fail to return for test results and treatment after the initial visit.

Methods In recent years, increased investment in the development of novel diagnostic technologies has resulted in advances that have made it possible to provide STI-testing at all healthcare settings. The development of multiplex tests to support screening and STI syndromic management in resource-limited settings is an urgent priority.

Results Exciting new technologies may soon transform how STIs can be diagnosed in resource-poor settings in the next few years. Among them are duplex antigen/antibody tests that can be used for STI syndromes and rapid lateral flow tests that can be used with oral fluid instead of blood for syphilis and HIV. Nucleic acid amplified tests that are designed as integrated platforms providing sample- in- answer-out convenience and random access will soon be available for the detection of genital chlamydial and gonococcal infections. Simple isothermal nucleic acid amplification technologies are available for detection of bacterial and viral STIs in 15–60 min, using simple equipment that can be run on solar energy or batteries. A mathematical model developed by Aledort et al (2006) estimated that a test for syphilis that requires no laboratory infrastructure could save more than 201 000 adjusted lives and avert 215 000 stillbirths. A similar test could save approximately 4 million DALYs, avert more than 16.5 million incident gonorrhoea and chlamydial infections and prevent more than 212 000 HIV infections.

Conclusions Recent investments in the development of point-of-care diagnostics for infectious diseases have produced novel technologies that can support STI screening and syndromic management in resource-limited settings. Quality assurance and implementation research are needed to ensure optimal uptake and full impact of these novel technologies in resource-limited settings.

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