Mbarara Regional Referral Hospital and Mbarara University of Science and Technology, Mbarara.
Makerere University, School of Public Health, Kampala, Uganda.
Sex Transm Dis. 2023 Oct 1;50(10):e11-e16. doi: 10.1097/OLQ.0000000000001848. Epub 2023 Jul 4.
Most sexually transmitted infections (STIs) are acquired in resource-limited settings (RLSs) where laboratory diagnostic access is limited. Advancements in point-of-care testing (POC) technology have the potential to bring STI testing to many RLSs. We define POC as performed near the patient and with results readily available to inform clinical practice. The World Health Organization Special Programme for Research and Training in Tropical Diseases further outlines desirable POC characteristics with the REASSURED criteria.Despite advantages related to immediate test-and-treat care, integrating POC into RLS health care systems can present challenges that preclude reliance on these tests. In 2018, we incorporated molecular near-POC for chlamydia, gonorrhea, and trichomoniasis and SDBioline treponemal immunochromatographic testing confirmed by rapid plasma reagin for syphilis diagnosis at the Mbarara University of Science and Technology Research Laboratory in rural southwestern Uganda. We describe our experiences with STI POC as a case example to guide a narrative review of the field using the Consolidated Framework for Implementation Research as a conceptual framework.Although POC and near-POC are described as easy to use, the challenges of limited person-power, health care processes, limited infrastructure/resources, high costs, and quality control obstacles can impede the impact of these tests. Increased investment in operators, training, and infrastructure, restructuring health care systems to accommodate increased POC access, and optimizing costs are all crucial to the successful implementation of STI POC in RLS. Expanded STI POC in RLS will increase access to accurate diagnoses, appropriate treatment, and engagement in partner notification, treatment, and prevention efforts.
大多数性传播感染(STI)是在资源有限的环境(RLS)中获得的,在这些环境中,实验室诊断途径有限。即时检测(POC)技术的进步有可能将 STI 检测带到许多 RLS。我们将 POCT 定义为在患者附近进行的检测,并且检测结果可以迅速获得,以便为临床实践提供信息。世界卫生组织热带病研究和培训特别规划署进一步概述了 POCT 的理想特征,包括 REASSURED 标准。尽管即时检测和即时治疗护理具有优势,但将 POCT 整合到 RLS 医疗保健系统中可能会带来挑战,从而无法依赖这些检测。2018 年,我们在乌干达西南部农村的姆巴拉拉科技大学研究实验室将分子即时 POCT 纳入衣原体、淋病和滴虫病的检测,并将 SDBioline 梅毒螺旋体免疫层析检测与快速血浆反应素结合,用于梅毒诊断。我们以 STI POC 为例,描述了我们的经验,以指导使用综合实施研究框架作为概念框架对该领域进行叙述性综述。尽管 POCT 和近 POCT 被描述为易于使用,但由于人员配备有限、医疗保健流程有限、基础设施/资源有限、成本高以及质量控制障碍等挑战,这些检测的影响可能会受到阻碍。增加对操作人员、培训和基础设施的投资,重组医疗保健系统以适应增加的 POC 通道,以及优化成本,对于在 RLS 中成功实施 STI POC 都是至关重要的。在 RLS 中扩大 STI POC 将增加获得准确诊断、适当治疗以及参与伴侣通知、治疗和预防工作的机会。
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