Introduction Sexually transmitted infections (STIs) continue to be a significant global public health issue. Rapid, inexpensive and easy-to-use point of care tests (POCTs) for syphilis, HIV, and trichomonas have become available and WHO pre-qualified. We surveyed public health workers from Africa to determine current STI POCT practices.
Methods From March to October 2016, we invited 7584 healthcare workers (HCW) to participate in an email survey using Qualtrics software. Email addresses were obtained from the Ministry of Health and a database of training attendees at the Infectious Diseases Institute over the last 6 years.
Results 555 participants (50% male) took the online survey. 91% were from Uganda. Most (n=449, 81%) were clinicians including 336 (61%) nurses and 113 (20%) clinical officers of Level III/IV health centres (40%). Among 449 clinician respondents, 312 (69%) reported seeing HIV/general patients and 309 (70%) diagnose at least one patient with an STI daily. Of 555 participants, common POCTs used were pregnancy test (74%), urine dipstick (71%), syphilis rapid test (66%) and Gram’s stain (53%). Clinicians reported that 86% of POCTs were performed by HCWs and 54% read the test while the patient was present. Most clinicians sent blood specimens for HIV (79%) and syphilis (64%) confirmation but only 18% routinely sent cultures for gonorrhoea. The majority of clinicians (74%) practiced syndromic diagnosis for STDs/HIV. Among all, lack of availability of POCTs (43%), increased patient wait time (25%), and lack of training to perform the test (21%) were leading barriers to scale up POCTs. Comparing those who use syphilis POCTs to those who do not, a interruption of work flow was the greatest barrier identified (20% versus 12%, p=0.042). 60% of clinician participants felt that having increased access to POCTs for STIs would be useful.
Conclusion Increase of POCT availability and training could improve uptake of POCTs for STIs in Uganda and decrease the need for syndromic management which may lead to overtreatment and emergence of antibiotic resistance.
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