Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK; Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.
Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe.
Lancet Child Adolesc Health. 2021 Feb;5(2):122-132. doi: 10.1016/S2352-4642(20)30335-7. Epub 2021 Jan 6.
The prevalence of sexually transmitted infections (STIs) among youth is high in sub-Saharan Africa. We investigated the uptake of testing for and prevalence of Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhoea) infections among youth in community-based settings in Zimbabwe, and explored the facilitators and barriers to testing.
This study was nested within a cluster randomised trial of community-based delivery of integrated HIV and sexual and reproductive health services for youth aged 16-24 years. Chlamydia and gonorrhoea testing via urine samples using the Xpert CT/NG test was offered in the four intervention clusters in Harare, Zimbabwe. Factors associated with testing uptake were investigated in a subset of participants (n=257) using hierarchical multivariate logistic regression. In-depth interviews with a separate purposively selected sample (n=26) explored facilitators and barriers to STI testing and partner notification and were analysed using thematic analysis.
Between June 1, 2019, and Jan 31, 2020, there were 6200 attendances by 4440 participants (78·2% women, 21·8% men) median age 20·3 (IQR 17·9-22·8) years. 1478 participants had 1501 tests done, and 248 tests were positive and 1253 tests were negative for chlamydia or gonorrhoea, or both. STI test uptake was 33·3% (95% CI 31·9-34·7), increasing from 11·7% in June, 2019, to 37·1% in January, 2020. The prevalence of chlamydia or gonorrhoea, or both, was 16·5% (95% CI 14·7-18·5; 248 of 1501), with only seven participants (3%) showing symptoms. The overall yield of testing was 4·0% (95% CI 3·5-4·5; 248 of 6200). Uptake was associated with having symptoms (adjusted odds ratio [OR] 14·8, 95% CI 1·66-132·07) and negatively associated with being single (adjusted OR 0·33, 95% CI 0·13-0·84) or having a boyfriend or girlfriend (adjusted OR 0·19, 95% CI 0·087-0·43) compared with being married, and being a student compared with being employed (adjusted OR 0·26, 95% CI 0·10-0·68). Perceived risk and symptoms of STIs were motivators for testing whereas misinformation, anticipated stigma, and concern about confidentiality were barriers.
The prevalence of chlamydia or gonorrhoea, or both, was high among youth but only a minority were symptomatic. Therefore most infections would remain untreated without access to STI testing. Provision of education, counselling, and confidentiality are essential to improve uptake and acceptability of STI testing.
Wellcome Trust.
在撒哈拉以南非洲，性传播感染（STI）在青年中的流行率很高。我们调查了津巴布韦社区环境中年轻人接受衣原体（淋病）和淋病检测的情况以及衣原体和淋病感染的流行率，并探讨了检测的促进因素和障碍。
本研究嵌套在一项针对 16-24 岁青年的社区为基础的综合艾滋病毒和性健康服务的集群随机试验中。在津巴布韦哈拉雷的四个干预集群中，通过尿液样本使用 Xpert CT/NG 检测提供淋病和淋病检测。使用分层多变量逻辑回归，在一组（n=257）参与者中调查了与检测率相关的因素。对一组（n=26）单独有目的地选择的参与者进行深入访谈，探讨性传播感染检测和性伴侣通知的促进因素和障碍，并使用主题分析进行分析。
2019 年 6 月 1 日至 2020 年 1 月 31 日，有 6200 次就诊，由 4440 名参与者（78.2%为女性，21.8%为男性）组成，中位数年龄为 20.3（IQR 17.9-22.8）岁。1478 名参与者进行了 1501 次检测，248 次检测呈阳性，1253 次检测呈阴性，表明淋病或淋病，或两者均呈阳性。性传播感染检测率为 33.3%（95%CI 31.9-34.7），从 2019 年 6 月的 11.7%上升到 2020 年 1 月的 37.1%。淋病或淋病，或两者的患病率为 16.5%（95%CI 14.7-18.5；1501 例中有 248 例），只有 7 名参与者（3%）出现症状。检测的总产率为 4.0%（95%CI 3.5-4.5；6200 例中有 248 例）。检测率与出现症状有关（调整后的优势比[OR]14.8，95%CI 1.66-132.07），与单身（调整后的 OR 0.33，95%CI 0.13-0.84）或有男朋友或女朋友（调整后的 OR 0.19，95%CI 0.087-0.43）相比，与已婚相比，与学生相比，与就业相比（调整后的 OR 0.26，95%CI 0.10-0.68），接受检测的可能性较低。对性传播感染的感知风险和症状是检测的动机，而错误信息、预期耻辱感和对保密性的担忧是检测的障碍。
淋病或淋病，或两者的患病率在年轻人中都很高，但只有少数人有症状。因此，如果没有获得性传播感染检测，大多数感染将得不到治疗。提供教育、咨询和保密性是提高性传播感染检测接受度和可接受性的关键。
惠康信托基金会。
