梅毒自我检测在重点人群中作为一种额外的梅毒检测方法的作用：系统评价和荟萃分析。

The role of syphilis self-testing as an additional syphilis testing approach in key populations: a systematic review and meta-analysis.

机构信息

Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Clayton, VIC, Australia.

Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland.

出版信息

Lancet Public Health. 2023 Sep;8(9):e726-e734. doi: 10.1016/S2468-2667(23)00128-7. Epub 2023 Jul 21.

DOI:10.1016/S2468-2667(23)00128-7

PMID:37482070

Abstract

BACKGROUND

Syphilis is causing epidemics in many countries. Syphilis self-testing (SST) has potential to increase testing and treatment coverage in the same manner as documented for self-testing of, for example, HIV, hepatitis C virus, and COVID-19. We aimed to synthesise current evidence on the utility of SST.

METHODS

We conducted a systematic review and, where possible, meta-analysis. We searched MEDLINE, Embase, CINAHL, Scopus, and Web of Science for publications published from Jan 1, 2000, to Oct 13, 2022. We included publications with original data on any syphilis rapid tests, including dual HIV-syphilis tests. Study populations were not restricted. We used random-effects meta-analysis to calculate the pooled proportion of people offered SST who undertook the test. The systematic review was registered in PROSPERO (CRD42022302129).

FINDINGS

In total, 40 499 citations were identified. 11 publications from seven studies from the USA, Zimbabwe, and China met eligibility criteria. Of those, four studies reported data from men who have sex with men and five studies used dual HIV-SST. Using data from one randomised controlled trial and three observational studies, the pooled proportion of people who received SST kits who undertook the test was 88% (95% CI 85-91). No studies provided data on the sensitivity or specificity of SST. Overall, user and provider preference for SST was high, with participants reporting convenience, privacy, rapid results, autonomy, trust in blood-based tests, decreased facility contact, and time savings, with individuals being able to correctly self-test. Publications from China reported that SST had lower costs per person tested than existing facility-based testing options.

INTERPRETATION

Our review builds on the literature for self-testing across different disease areas and demonstrates that SST has the potential to reach underserved populations. As this review found that SST use was acceptable and feasible to implement, SST can be used as an additional syphilis testing approach. Since no data on the sensitivity and specificity of SST were found, further implementation research will be required to guide the best strategies for SST service delivery and future scale-up.

FUNDING

WHO, Australian National Health and Medical Research Council, and Unitaid.

摘要

背景

梅毒在许多国家引发流行。梅毒自检（SST）有可能像 HIV、丙型肝炎病毒和 COVID-19 自检那样，提高检测和治疗的覆盖率。我们旨在综合评估 SST 的效用。

方法

我们进行了系统评价，并在可能的情况下进行了荟萃分析。我们检索了 MEDLINE、Embase、CINAHL、Scopus 和 Web of Science 从 2000 年 1 月 1 日至 2022 年 10 月 13 日发表的文献。我们纳入了包含任何梅毒快速检测（包括双重 HIV-梅毒检测）原始数据的出版物。研究人群不受限制。我们使用随机效应荟萃分析计算了接受 SST 检测的接受检测者的比例。系统评价已在 PROSPERO（CRD42022302129）中注册。

发现

共识别出 40499 个引文。来自美国、津巴布韦和中国的 7 项研究的 11 篇出版物符合入选标准。其中，4 项研究报告了男男性行为者的数据，5 项研究使用了双重 HIV-SST。使用来自一项随机对照试验和三项观察性研究的数据，接受 SST 试剂盒的人接受检测的比例为 88%（95%CI 85-91）。没有研究提供 SST 的敏感性或特异性的数据。总体而言，SST 的使用者和提供者都非常喜欢 SST，参与者报告说 SST 方便、隐私、结果快速、自主、对基于血液的检测的信任、减少与医疗机构的接触以及节省时间，并且个人能够正确地进行自我检测。来自中国的出版物报告说，SST 的人均检测成本低于现有的基于医疗机构的检测选项。

解释

我们的综述建立在不同疾病领域的自我检测文献基础上，表明 SST 有可能覆盖未得到满足的人群。由于我们的综述发现 SST 的使用是可以接受的，并且可以实施，因此 SST 可以作为另一种梅毒检测方法。由于没有关于 SST 的敏感性和特异性的数据，因此需要进一步的实施研究来指导 SST 服务提供的最佳策略和未来的扩大。