Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland.
Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
Sex Transm Infect. 2020 Aug;96(5):342-347. doi: 10.1136/sextrans-2019-054358. Epub 2020 Apr 2.
OBJECTIVES: In 2016, WHO estimated 376 million new cases of the four main curable STIs: gonorrhoea, chlamydia, trichomoniasis and syphilis. Further, an estimated 290 million women are infected with human papillomavirus. STIs may lead to severe reproductive health sequelae. Low-income and middle-income countries carry the highest global burden of STIs. A large proportion of urogenital and the vast majority of extragenital non-viral STI cases are asymptomatic. Screening key populations and early and accurate diagnosis are important to provide correct treatment and to control the spread of STIs. This article paints a picture of the state of technology of STI point-of-care testing (POCT) and its implications for health system integration. METHODS: The material for the STI POCT landscape was gathered from publicly available information, published and unpublished reports and prospectuses, and interviews with developers and manufacturers. RESULTS: The development of STI POCT is moving rapidly, and there are much more tests in the pipeline than in 2014, when the first STI POCT landscape analysis was published on the website of WHO. Several of the available tests need to be evaluated independently both in the laboratory and, of particular importance, in different points of care. CONCLUSION: This article reiterates the importance of accurate, rapid and affordable POCT to reach universal health coverage. While highlighting the rapid technical advances in this area, we argue that insufficient attention is being paid to health systems capacity and conditions to ensure the swift and rapid integration of current and future STI POCT. Unless the complexity of health systems, including context, institutions, adoption systems and problem perception, are recognised and mapped, simplistic approaches to policy design and programme implementation will result in poor realisation of intended outcomes and impact.
目的:2016 年,世卫组织估计有 3.76 亿例淋病、衣原体、滴虫病和梅毒这四种主要可治愈性传播感染新发病例。此外,约有 2.9 亿名妇女感染了人乳头瘤病毒。性传播感染可导致严重的生殖健康后遗症。中低收入国家承担着全球最大的性传播感染负担。很大一部分泌尿生殖道和绝大多数外阴生殖道非病毒性性传播感染病例为无症状。对重点人群进行筛查,以及及早和准确诊断,对于提供正确治疗和控制性传播感染的传播至关重要。本文描述了性传播感染即时检测(POCT)技术现状及其对卫生系统整合的影响。
方法:性传播感染 POCT 领域的相关资料来源于公开信息、已发表和未发表的报告和计划书,以及对开发商和制造商的访谈。
结果:性传播感染 POCT 的发展正在迅速推进,目前可供使用的检测方法比 2014 年首次发表在世卫组织网站上的性传播感染 POCT 全景分析时多得多。一些现有的检测方法需要在实验室中进行独立评估,特别是在不同的护理点,这一点非常重要。
结论:本文重申了准确、快速和经济实惠的 POCT 对实现全民健康覆盖的重要性。虽然本文强调了该领域的快速技术进步,但我们认为,人们对卫生系统能力和条件的重视程度不足,无法确保当前和未来的性传播感染 POCT 能够迅速得到采用。除非认识到并绘制出卫生系统的复杂性,包括背景、机构、采用系统和问题认知,否则对政策设计和方案实施采取过于简单的方法,将导致预期结果和影响的实现效果不佳。
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