INTRODUCTION: Given the synergistic relationship between HIV and sexually transmitted infections (STI), the integration of services has the potential to reduce the incidence of both HIV and STIs. We explored the extent to which STI testing has been offered within HIV pre-exposure prophylaxis (PrEP) programmes worldwide. METHODS: We conducted a systematic review of PrEP programmes implementing STI testing services in nine databases. We approached PrEP implementers for additional unpublished data and implementation details. Descriptive statistics were used to present the characteristics of STI testing within PrEP programmes. Content analysis of the input from PrEP implementers was conducted to summarize the barriers to and facilitators of STI testing. RESULTS: Of 9,161 citations, 91 studies conducted in 32 countries were included: 69% from high-income countries (HICs) and 64% from programmes targeting men who have sex with men (MSM) and transgender women (TGW) only. The majority of programmes (70%, 64/91) conducted STI testing before the initiation of PrEP. The most common STIs tested were gonorrhoea (86%, 78/91), chlamydia (84%, 76/91) and syphilis (84%, 76/91). The majority provided STI testing at three-month intervals (70%, 53/76, for syphilis; 70% 53/78, for chlamydia; 68%, 53/78, for gonorrhoea). Relative to low- and middle-income countries (LMICs), a higher proportion of PrEP programmes in HICs offered testing for gonorrhoea (92% vs. 71%, p < 0.05), chlamydia (92% vs. 64%, p < 0.01), syphilis (87% vs. 75%, p < 0.05), hepatitis A (18% vs. 4%, p < 0.05) and hepatitis C (43% vs. 21%, p < 0.05); offered testing for a higher number of STIs (mean 3.75 vs. 3.04, p < 0.05); and offered triple (throat, genital/urine and anorectal) anatomical site screening (54% vs. 18%, p < 0.001). Common implementation challenges included costs, access to STI diagnostics, programme logistics of integrating STI testing into PrEP delivery models and lack of capacity building for staff involved in PrEP provision. CONCLUSIONS: Significant gaps and challenges remain in the provision of STI testing services within HIV PrEP programmes. We recommend more active integration of STI testing and management into PrEP programmes, supported by standardized practice guidelines, staff capacity building training and adequate funding. This could lead to improved sexual health and HIV outcomes in key populations.
INTRODUCTION: Given the synergistic relationship between HIV and sexually transmitted infections (STI), the integration of services has the potential to reduce the incidence of both HIV and STIs. We explored the extent to which STI testing has been offered within HIV pre-exposure prophylaxis (PrEP) programmes worldwide. METHODS: We conducted a systematic review of PrEP programmes implementing STI testing services in nine databases. We approached PrEP implementers for additional unpublished data and implementation details. Descriptive statistics were used to present the characteristics of STI testing within PrEP programmes. Content analysis of the input from PrEP implementers was conducted to summarize the barriers to and facilitators of STI testing. RESULTS: Of 9,161 citations, 91 studies conducted in 32 countries were included: 69% from high-income countries (HICs) and 64% from programmes targeting men who have sex with men (MSM) and transgender women (TGW) only. The majority of programmes (70%, 64/91) conducted STI testing before the initiation of PrEP. The most common STIs tested were gonorrhoea (86%, 78/91), chlamydia (84%, 76/91) and syphilis (84%, 76/91). The majority provided STI testing at three-month intervals (70%, 53/76, for syphilis; 70% 53/78, for chlamydia; 68%, 53/78, for gonorrhoea). Relative to low- and middle-income countries (LMICs), a higher proportion of PrEP programmes in HICs offered testing for gonorrhoea (92% vs. 71%, p < 0.05), chlamydia (92% vs. 64%, p < 0.01), syphilis (87% vs. 75%, p < 0.05), hepatitis A (18% vs. 4%, p < 0.05) and hepatitis C (43% vs. 21%, p < 0.05); offered testing for a higher number of STIs (mean 3.75 vs. 3.04, p < 0.05); and offered triple (throat, genital/urine and anorectal) anatomical site screening (54% vs. 18%, p < 0.001). Common implementation challenges included costs, access to STI diagnostics, programme logistics of integrating STI testing into PrEP delivery models and lack of capacity building for staff involved in PrEP provision. CONCLUSIONS: Significant gaps and challenges remain in the provision of STI testing services within HIVPrEP programmes. We recommend more active integration of STI testing and management into PrEP programmes, supported by standardized practice guidelines, staff capacity building training and adequate funding. This could lead to improved sexual health and HIV outcomes in key populations.
Authors: Robert M Grant; Javier R Lama; Peter L Anderson; Vanessa McMahan; Albert Y Liu; Lorena Vargas; Pedro Goicochea; Martín Casapía; Juan Vicente Guanira-Carranza; Maria E Ramirez-Cardich; Orlando Montoya-Herrera; Telmo Fernández; Valdilea G Veloso; Susan P Buchbinder; Suwat Chariyalertsak; Mauro Schechter; Linda-Gail Bekker; Kenneth H Mayer; Esper Georges Kallás; K Rivet Amico; Kathleen Mulligan; Lane R Bushman; Robert J Hance; Carmela Ganoza; Patricia Defechereux; Brian Postle; Furong Wang; J Jeff McConnell; Jia-Hua Zheng; Jeanny Lee; James F Rooney; Howard S Jaffe; Ana I Martinez; David N Burns; David V Glidden Journal: N Engl J Med Date: 2010-11-23 Impact factor: 91.245
Authors: Jean-Michel Molina; Catherine Capitant; Bruno Spire; Gilles Pialoux; Laurent Cotte; Isabelle Charreau; Cecile Tremblay; Jean-Marie Le Gall; Eric Cua; Armelle Pasquet; François Raffi; Claire Pintado; Christian Chidiac; Julie Chas; Pierre Charbonneau; Constance Delaugerre; Marie Suzan-Monti; Benedicte Loze; Julien Fonsart; Gilles Peytavin; Antoine Cheret; Julie Timsit; Gabriel Girard; Nicolas Lorente; Marie Préau; James F Rooney; Mark A Wainberg; David Thompson; Willy Rozenbaum; Veronique Doré; Lucie Marchand; Marie-Christine Simon; Nicolas Etien; Jean-Pierre Aboulker; Laurence Meyer; Jean-François Delfraissy Journal: N Engl J Med Date: 2015-12-01 Impact factor: 91.245
Authors: Andrew E Grulich; Rebecca Guy; Janaki Amin; Fengyi Jin; Christine Selvey; Jo Holden; Heather-Marie A Schmidt; Iryna Zablotska; Karen Price; Bill Whittaker; Kerry Chant; Craig Cooper; Scott McGill; Barbara Telfer; Barbara Yeung; Gesalit Levitt; Erin E Ogilvie; Nila J Dharan; Mohamed A Hammoud; Stefanie Vaccher; Lucy Watchirs-Smith; Anna McNulty; David J Smith; Debra M Allen; David Baker; Mark Bloch; Rohan I Bopage; Katherine Brown; Andrew Carr; Christopher J Carmody; Kym L Collins; Robert Finlayson; Rosalind Foster; Eva Y Jackson; David A Lewis; Josephine Lusk; Catherine C O'Connor; Nathan Ryder; Emanuel Vlahakis; Phillip Read; David A Cooper Journal: Lancet HIV Date: 2018-10-17 Impact factor: 12.767
Authors: Eric P F Chow; Denton Callander; Christopher K Fairley; Lei Zhang; Basil Donovan; Rebecca Guy; David A Lewis; Margaret Hellard; Phillip Read; Alison Ward; Marcus Y Chen Journal: Clin Infect Dis Date: 2017-08-01 Impact factor: 9.079
Authors: Jane Rowley; Stephen Vander Hoorn; Eline Korenromp; Nicola Low; Magnus Unemo; Laith J Abu-Raddad; R Matthew Chico; Alex Smolak; Lori Newman; Sami Gottlieb; Soe Soe Thwin; Nathalie Broutet; Melanie M Taylor Journal: Bull World Health Organ Date: 2019-06-06 Impact factor: 9.408
Authors: Jason J Ong; Rachel C Baggaley; Teodora E Wi; Joseph D Tucker; Hongyun Fu; M Kumi Smith; Sabrina Rafael; Vanessa Anglade; Jane Falconer; Richard Ofori-Asenso; Fern Terris-Prestholt; Ioannis Hodges-Mameletzis; Philippe Mayaud Journal: JAMA Netw Open Date: 2019-12-02
Authors: Jason J Ong; Hongyun Fu; Rachel C Baggaley; Teodora E Wi; Joseph D Tucker; M Kumi Smith; Sabrina Rafael; Jane Falconer; Fern Terris-Prestholt; Ioannis Mameletzis; Phillipe Mayaud Journal: J Int AIDS Soc Date: 2021-02 Impact factor: 5.396