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Anorectal gonorrhoea and chlamydia among transgender women in Brazil: prevalence and assessment of performance and cost of anorectal infection detection and management approaches
  1. Daniel Jason McCartney1,
  2. Carla Gianna Luppi2,
  3. Roberto José Carvalho Silva2,
  4. Sandra de Araújo2,
  5. Katia Cristina Bassichetto3,4,
  6. Philippe Mayaud1,
  7. Maria Amélia Veras3,4
  8. for the TransOdara Research Group
    1. 1 Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
    2. 2 Centro de Referência e Treinamento em DST/Aids, Secretaria da Saúde do Estado de São Paulo, Sao Paulo, Brazil
    3. 3 Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
    4. 4 Núcleo de Pesquisa e Direitos Humanos em Saúde da População LGBT+ (NUDHES), São Paulo, Brazil
    1. Correspondence to Dr Daniel Jason McCartney, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK; daniel.mccartney{at}lshtm.ac.uk

    Abstract

    Objectives We aimed to determine the prevalence of anorectal Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) among transgender women in Brazil, and to assess the performance and costs of various approaches for the diagnosis and management of anorectal NG/CT.

    Methods TransOdara was a multicentric, cross-sectional STI prevalence study among 1317 transgender women conducted in five capital cities representing all Brazilian regions. Participants aged >18 years were recruited using respondent-driven sampling (RDS), completed an interviewer-led questionnaire, offered an optional physical examination and given choice between self-collected or provider-collected samples for NG/CT testing. Performance and cost indicators of predetermined management algorithms based on the WHO recommendations for anorectal symptoms were calculated.

    Results Screening uptake was high (94.3%) and the estimated prevalence of anorectal NG, CT and NG and/or CT was 9.1%, 8.9% and 15.2%, respectively. Most detected anorectal NG/CT infections were asymptomatic (NG: 87.6%, CT: 88.9%), with a limited number of participants reporting any anorectal symptoms (9.1%). Of those who permitted anal examination, few had clinical signs of infection (13.6%). Sensitivity of the tested algorithms ranged from 1.4% to 5.1% (highest for treatment based on the reported anorectal discharge or ulcer and receptive anal intercourse (RAI) in the past 6 months) and specificity from 98.0% to 99.3% (highest for treatment based on the reported anorectal discharge with clinical confirmation or report of RAI). The estimated cost-per-true case of anorectal NG/CT infection treated varied from lowest providing treatment for anorectal discharge syndrome based on the reported RAI ($2.70–4.28), with algorithms including clinical examinations decreasing cost-effectiveness.

    Conclusions High prevalence of mostly asymptomatic anorectal NG and CT was observed among Brazilian transgender women. Multi-site NG/CT screening should be offered to transgender women. Where diagnostic testing capacity is limited, syndromic management for those presenting with anorectal symptoms is recommended.

    • Neisseria gonorrhoeae
    • Chalmydia Trachomatis
    • Transgender Persons
    • Diagnostic Techniques and Procedures

    Data availability statement

    Data are available upon reasonable request. Extracted data are available on request to the corresponding author.

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    Data availability statement

    Data are available upon reasonable request. Extracted data are available on request to the corresponding author.

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    Footnotes

    • Handling editor Eric PF Chow

    • Twitter @djmccartney

    • Correction notice This article has been corrected since it was first published. The author affiliations have been updated.

    • Collaborators TransOdara Research Group: Maria Amélia de SM Veras, Maria Inês Costa Dourado, Thiago Pinheiro, Ana Rita C Motta Castro, Andrea Fachel Leal, Bruno Puccinelli, Carla Gianna Luppi, Claudia Renata dos Santos Barros, Daniela Knauth, Daniel McCartney, Philippe Mayaud, Roberto Carvalho, Katia Cristina Bassichetto, Maria Aparecida da Silva, Rita Bacuri, Thiago Pestana, Laio Magno, Sandra Brasil, Luisa Lina Villa, Willi McFarland, Erin Wilson, Mariana Veloso, Alícia Kruger, Ana Roberta Patti Pascon, Adele Benzaken, Maria Luíza Bazzo, Gwenda Hughes, Carmem Freitas Oliveira, Luis Fernando Brígido, Regina Célia Moreira, Adriana Parise Compri, Edilene Peres Real da Silveira, Elaine Lopes de Oliveira, Marcia Jorge Castejon, Neuza Satomi Sato, Rosemeire Yamashiro; Sandra Araújo, Mara Cristina Scheffer, Lisléia Golfetto, Dariana Pimentel Gomes Hübner, Patrícia Puccinelli Orlandi Nogueira, Leonardo Soares Bastos, Francisco Inácio Bastos, Sandro Leonardo Martins Sperandei, Camila Mattos dos Santos.

    • Contributors DJMc: Planning, analysis, interpretation of results and writer of the paper. CGL: Study conception, planning and execution, interpretation of results and reviewing of the paper. RJCS: Data collection, interpretation of results and writing of the paper. SdA: Data collection, interpretation of results and reviewing of the paper. KCB: Monitoring and evaluating quality of data collected, interpretation of results and writing of the paper. PM: Study conception, analysis, interpretation of results and writing of the paper. MAV: Study conception, planning and execution, interpretation of results, writing of the paper and guarantor. All authors approved the final submitted manuscript.

    • Funding The TransOdara study was funded by the Pan American Health Organization (PAHO) and the Ministry of Health of Brazil – Department of Chronic Conditions and Sexually Transmitted Infections (DCCI) (Agreement n°: SCON2019-00162). The first author (DJMc) received a Doctoral Project Travelling Scholarship from the London School of Hygiene & Tropical Medicine, UK.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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