A Population-Specific Optimized GeneXpert Pooling Algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae To Reduce Cost of Molecular Sexually Transmitted Infection Screening in Resource-Limited Settings
- 1 September 2020
- journal article
- research article
- Published by American Society for Microbiology in Journal of Clinical Microbiology
- Vol. 58 (9)
- https://doi.org/10.1128/JCM.00176-20
Abstract
The sexually transmitted infections (STIs) chlamydia (CT) and gonorrhea (NG) are often asymptomatic in women and undetected by syndromic management, leading to complications such as pelvic inflammatory disease, infertility, and ectopic pregnancy. Molecular testing, such as the GeneXpert CT/NG assay, is highly sensitive, but cost restraints preclude implementation of these technologies in resourcelimited settings. Pooled testing is one strategy to reduce the cost per sample, but the extent of savings depends on disease prevalence. The current study describes a pooling strategy based on identification of sociodemographic and laboratory factors associated with CT/NG prevalence in a high-risk cohort of Zambian female sex workers and single mothers conducted from 2016 to 2019. Factors associated with testing positive for CT/NG via logistic regression modeling included city, younger age, lower education, long-acting reversible contraception usage, Trichomonas vaginalis infection, bacterial vaginosis, and incident syphilis infection. Based on these factors, the study population was stratified into high-, intermediate-, and low-prevalence subgroups and tested accordingly-individually, pools of 3, or pools of 4, respectively. The cost per sample was reduced from $18 to as low as 59.43 in the low-prevalence subgroup. The checklist tool and pooling approach described can be used in a variety of treatment algorithms to lower the cost per sample and increase access to molecular STI screening. This is particularly valuable in resource-limited settings to detect and treat asymptomatic CT/NG infections missed by traditional syndromic management.Funding Information
- AIDS International Training and Research Program Fogarty International Center (D43 TW001042)
- Emory Center for AIDS Research (P30 AI050409)
- Emory Global Health Institute
- Sub-Saharan African Network for TB/HIV Research Excellence
- HHS | NIH | National Institute of Allergy and Infectious Diseases (R01 AI51231)
- HHS | NIH | National Institute of Allergy and Infectious Diseases (R01 AI040951)
- HHS | NIH | National Institute of Allergy and Infectious Diseases (R01 AI023980)
- HHS | NIH | National Institute of Allergy and Infectious Diseases (R01 AI64060)
- Burroughs Wellcome Fund
- United States Agency for International Development
- HHS | NIH | National Institute of Mental Health (R01 66767)
- International AIDS Vaccine Initiative
- HHS | NIH | Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01 HD40125)
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