Evidence map›Paper›PMID 29689080›Full record

ArticlePloS one2018

Beyond syndromic management: Opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries.

Nigel J Garrett, Farzana Osman, Bhavna Maharaj, Nivashnee Naicker, Andrew Gibbs, Emily Norman, Natasha Samsunder, Hope Ngobese, Nireshni Mitchev, Ravesh Singh and 5 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 77 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
77citing papers in PubMed, 4 pooled it
11.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

77 citing papers in PubMed, 4 syntheses or guidelines pooled it, 145 citations in OpenAlex.

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17 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 6 institutions in 2 countries.

Nigel J GarrettCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.ORCID 0000-0002-4530-234X
Farzana OsmanCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
Bhavna MaharajCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.ORCID 0000-0003-1935-4637
Nivashnee NaickerCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
Andrew GibbsSouth African Medical Research Council, Durban, South Africa.ORCID 0000-0003-2812-5377
Emily NormanCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
Natasha SamsunderCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
Hope NgobesePrince Cyril Zulu Communicable Disease Centre, eThekwini Municipality, Durban, South Africa.
Nireshni MitchevDepartment of Microbiology, University of KwaZulu-Natal, Durban, South Africa.
Ravesh SinghDepartment of Microbiology, University of KwaZulu-Natal, Durban, South Africa.
Salim S Abdool KarimCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.ORCID 0000-0002-4986-2133
Ayesha B M KharsanyCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
Koleka MlisanaDepartment of Microbiology, University of KwaZulu-Natal, Durban, South Africa.ORCID 0000-0002-8436-3268
Anne RompaloJohns Hopkins University, Baltimore, United States of America.ORCID 0000-0001-6398-9061
Adrian MindelCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.ORCID 0000-0002-8780-9982
Centre for the AIDS Programme of Research in South Africa · ZANational Health Laboratory Service · ZAeThekwini Municipality · ZAJohns Hopkins University · USSouth African Medical Research Council · ZAUniversity of KwaZulu-Natal · ZA

Funding

Enhanced STI management to reduce genital inflammation and HIV riskR21AI116759 · NIAID · CENTRE/AIDS PROGRAMME/RES/SOUTH AFRICA · PI GARRETT, NIGEL JOEL, ROMPALO, ANNE M · 2015 to 2016
$297k
NIAID NIH HHS R21 AI116759NIH HHS AI116759
6 · The paper itself

Abstract

introductionIn light of the limited impact the syndromic management approach has had on the global sexually transmitted infection (STI) epidemic, we assessed a care model comprising point-of-care (POC) STI testing, immediate treatment, and expedited partner therapy (EPT) among a cohort of young women at high HIV risk in South Africa. METHODS AND

findingsHIV negative women presenting for STI care underwent POC testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV), and swabs were sent for NG culture and susceptibility testing. Results were available within 2 hours and women with STIs were immediately treated and offered EPT packs, including medication, condoms, and information for sexual partners. An EPT questionnaire was administered after one week, and women retested for STIs after 6 and 12 weeks. 267 women, median age 23 (IQR 21-26), were recruited and 88.4% (236/267) reported genital symptoms. STI prevalence was CT 18.4% (95%CI 13.7-23.0), NG 5.2% (95%CI 2.6-7.9) and TV 3.0% (95%CI 1.0-5.0). After 12 weeks, all but one NG and two CT infections were cleared. No cephalosporin-resistant NG was detected. Of 63/267 women (23.6%) diagnosed with STIs, 98.4% (62/63) were offered and 87.1% (54/62) accepted EPT. At one week 88.9% (48/54) stated that their partner had taken the medication. No allergic reactions or social harms were reported. Of 51 women completing 6-week follow up, detection rates were lower amongst women receiving EPT (2.2%, 1/46) compared to those who did not (40.0%, 2/5), p = 0.023. During focus group discussions women supported the care model, because they received a rapid, specific diagnosis, and could facilitate their partners' treatment.

conclusionsPOC STI testing and EPT were acceptable to young South African women and their partners, and could play an important role in reducing STI reinfection rates and HIV risk. Larger studies should evaluate the feasibility and cost-effectiveness of implementing this strategy at population level.

Indexed as

AdultChlamydia InfectionsFemaleGonorrheaHumansPilot ProjectsPoint-of-Care TestingPovertyPrevalenceProspective StudiesSexually Transmitted DiseasesSexual PartnersSouth AfricaSurveys and QuestionnairesTreatment OutcomeTrichomonas Vaginitis

Identifiers

PMID29689080
PMCPMC5918163
OpenAlexW2803019047

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.