Determining the screening frequency for sexually transmitted infections for people who use HIV pre-exposure prophylaxis: a systematic review and meta-analysis

Cham-mill Kim, Victor Zhao, Maeve Brito de Mello, Rachel Baggaley, Cheryl C. Johnson, Erica Spielman, Christopher K. Fairley, Lei Zhang, Henry de Vries, Jeffrey Klausner, Rui Zhao, Jason J. Ong

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Abstract

Objectives: Although the World Health Organization recommends ‘frequent’ screening of sexually transmitted infections (STI) for people who use pre-exposure prophylaxis for HIV, there is no evidence for optimal frequency. Methods: We searched five databases and used random-effects meta-analysis to calculate pooled estimates of STI test positivity. We narratively synthesized data on secondary outcomes, including adherence to recommended STI screening frequency and changes in STI epidemiology. Results: Of 7477 studies, we included 38 for the meta-analysis and 11 for secondary outcomes. With 2-3 monthly STI screening, the pooled positivity was 0.20 (95% confidence interval [CI]: 0.15-0.25) for chlamydia, 0.17 (95% CI: 0.12-0.22) for gonorrhea, and 0.07 (95% CI: 0.05-0.08) for syphilis. For chlamydia and gonorrhea, the positivity was approximately 50% and 75% lower, respectively, in studies that screened 4-6 monthly vs 2-3 monthly. There was no significant difference in the positivity for syphilis in studies that screened 4-6 monthly compared to 2-3 monthly. Adherence of clients to recommended screening frequency varied significantly (39-94%) depending on population and country. Modeling studies suggest more frequent STI screening could reduce incidence. Conclusion: Although more frequent STI screening could reduce delayed diagnoses and incidence, there remain significant knowledge gaps regarding the optimal STI screening frequency.
Original languageEnglish
Pages (from-to)181-187
Number of pages7
JournalInternational Journal of Infectious Diseases
Volume129
DOIs
Publication statusPublished - 1 Apr 2023

Keywords

  • HIV
  • PrEP
  • Pre-exposure prophylaxis
  • Screening
  • Sexually transmitted infections

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