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Poster Presentations
PS01 – POSTER VIEWING SESSION – MONDAY
Monday, July 15, 2019 5:45 PM – 7:00 PM
P024 Targeted point-of-care testing compared to syndromic management of urogenital infections in rwandan women
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  1. Janneke Van De Wijgert1,
  2. Marijn Verwijs2,
  3. Stephen Agaba3,
  4. Jean Claude Sumanyi3,
  5. Marie Michelle Umulisa3,
  6. Lambert Mwambarangwe3,
  7. Viateur Musengamana3,
  8. Mireille Uwineza3,
  9. Vicky Cuylaerts4,
  10. Tania Crucitti4,
  11. Vicky Jespers4
  1. 1University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
  2. 2University of Liverpool, Institute of Infection and Global Health, Liverpool, UK
  3. 3Rinda Ubuzima, Kigali, Rwanda
  4. 4Institute of Tropical Medicine, Antwerp, Belgium

Abstract

Background Sexually transmitted and urogenital infections are typically managed by World Health Organisation (WHO)-recommended syndromic algorithms in resource-poor countries. Vaginal discharge (VDS) and lower abdominal pain (LAP) algorithms in women perform poorly. The main aim of the WISH study was to compare the performances of VDS/LAP algorithms incorporating point-of-care tests (POCTs), and of WHO syndromic algorithms, with gold standard test results.

Methods At-risk Rwandan women (N=705) underwent POCTs for bacterial vaginosis (BV; vaginal pH≥5·0) and Trichomonas vaginalis (TV; OSOM) regardless of symptom-reporting. Women with a positive risk score were POC-tested for Chlamydia trachomatis and Neisseria gonorrhoeae (CT/NG; GeneXpert). Vulvovaginal candidiasis (VVC) was treated presumptively. Nucleic acid amplification tests (NAATs) were done for CT/NG, TV, BV, and VVC on everyone and were used as gold standards.

Results NAAT-based prevalences were: 60/705 (8·5%) CT, 50/705 (7·1%) NG, 111/690 (16·1%) TV, 125/690 (18·1%) BV, and 59/690 (8·6%) VVC. Infection-specific sensitivities of the WHO VDS/LAP algorithms ranged from 58·3–74·6%, and specificities from 44·7–50·6%. WISH POCT-based algorithms had good sensitivity (68·5–76·0%) and specificity (97·4–100%) for CT, NG, and TV but low specificity for BV (41·2%; sensitivity 95·2%), and modest sensitivity (64·4%) and specificity (69·4%) for VVC. Sensitivity (73·6%) and specificity (100%) for BV improves by screening all women for vaginal pH, and confirmatory testing of those with pH≥5·5 (n=275). Speculum/bimanual examinations by a physician had limited added value (except in the case of LAP), and partner notification was suboptimal. Staff and participants considered POC testing feasible and acceptable.

Conclusion POC testing for urogenital infections in women improves performance and is feasible in resource-poor settings. The WHO VDS/LAP algorithms should therefore recommend POC testing whenever feasible. However, programmes would benefit from more affordable combined CT/NG POCTs, and POCTs combining BV, TV, and VVC diagnoses. Additional studies in other populations, including low prevalence populations, are warranted.

Disclosure No significant relationships.

  • diagnosis

https://doi.org/10.1136/sextrans-2019-sti.233

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