在高负担地区针对孕妇性传播感染的一种新型即时检测策略：巴布亚新几内亚可行性研究结果
A novel point-of-care testing strategy for sexually transmitted infections among pregnant women in high-burden settings: results of a feasibility study in Papua New Guinea.
作者信息
Badman Steven G, Vallely Lisa M, Toliman Pamela, Kariwiga Grace, Lote Bomesina, Pomat William, Holmer Caroline, Guy Rebecca, Luchters Stanley, Morgan Chris, Garland Suzanne M, Tabrizi Sepehr, Whiley David, Rogerson Stephen J, Mola Glen, Wand Handan, Donovan Basil, Causer Louise, Kaldor John, Vallely Andrew
机构信息
The Kirby Institute, University of New South Wales, Sydney, Australia.
Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
出版信息
BMC Infect Dis. 2016 Jun 6;16:250. doi: 10.1186/s12879-016-1573-4.
BACKGROUND
Sexually transmitted and genital infections in pregnancy are associated with an increased risk of adverse maternal and neonatal health outcomes. High prevalences of sexually transmitted infections have been identified among antenatal attenders in Papua New Guinea. Papua New Guinea has amongst the highest neonatal mortality rates worldwide, with preterm birth and low birth weight major contributors to neonatal mortality. The overall aim of our study was to determine if a novel point-of-care testing and treatment strategy for the sexually transmitted and genital infections Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Bacterial vaginosis (BV) in pregnancy is feasible in the high-burden, low-income setting of Papua New Guinea.
METHODS
Women attending their first antenatal clinic visit were invited to participate. CT/NG and TV were tested using the GeneXpert platform (Cepheid, USA), and BV tested using BVBlue (Gryphus Diagnostics, USA). Participants received same-day test results and antibiotic treatment as indicated. Routine antenatal care including HIV and syphilis screening were provided.
RESULTS
Point-of-care testing was provided to 125/222 (56 %) of women attending routine antenatal care during the three-month study period. Among the 125 women enrolled, the prevalence of CT was 20.0 %; NG, 11.2 %; TV, 37.6 %; and BV, 17.6 %. Over half (67/125, 53.6 %) of women had one or more of these infections. Most women were asymptomatic (71.6 %; 47/67). Women aged 24 years and under were more likely to have one or more STI compared with older women (odds ratio 2.38; 95 % CI: 1.09, 5.21). Most women with an STI received treatment on the same day (83.6 %; 56/67). HIV prevalence was 1.6 % and active syphilis 4.0 %.
CONCLUSION
Point-of-care STI testing and treatment using a combination of novel, newly-available assays was feasible during routine antenatal care in this setting. This strategy has not previously been evaluated in any setting and offers the potential to transform STI management in pregnancy and to prevent their associated adverse health outcomes.
背景
孕期性传播感染和生殖道感染与孕产妇及新生儿不良健康结局风险增加相关。在巴布亚新几内亚，已发现产前检查者中性传播感染的患病率很高。巴布亚新几内亚是全球新生儿死亡率最高的国家之一，早产和低出生体重是新生儿死亡的主要原因。我们研究的总体目标是确定一种针对孕期沙眼衣原体（CT）、淋病奈瑟菌（NG）、阴道毛滴虫（TV）和细菌性阴道病（BV）等性传播和生殖道感染的新型即时检测及治疗策略，在巴布亚新几内亚高负担、低收入环境中是否可行。
方法
邀请首次到产前诊所就诊的女性参与。使用GeneXpert平台（美国赛沛公司）检测CT/NG和TV，使用BVBlue（美国格里弗斯诊断公司）检测BV。参与者当天即可获得检测结果，并根据检测结果接受抗生素治疗。提供包括艾滋病毒和梅毒筛查在内的常规产前护理。
结果
在为期三个月的研究期间，为125/222（56%）名接受常规产前护理的女性提供了即时检测。在纳入研究的125名女性中，CT患病率为20.0%；NG为11.2%；TV为37.6%；BV为17.6%。超过一半（67/125，53.6%）的女性感染了上述一种或多种疾病。大多数女性无症状（71.6%；47/67）。与年龄较大的女性相比，24岁及以下的女性更有可能感染一种或多种性传播感染（比值比2.38；95%置信区间：1.09，5.21）。大多数感染性传播感染的女性在当天接受了治疗（83.6%；56/67）。艾滋病毒患病率为1.6%，活动性梅毒患病率为4.0%。
结论
在这种情况下，在常规产前护理期间，使用新型、新可用检测方法组合进行即时性传播感染检测和治疗是可行的。此前在任何环境中均未对该策略进行过评估，它有可能改变孕期性传播感染的管理方式，并预防其相关的不良健康结局。
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