TY - JOUR
T1 - Determining the screening frequency for sexually transmitted infections for people who use HIV pre-exposure prophylaxis
T2 - a systematic review and meta-analysis
AU - Kim, Cham-mill
AU - Zhao, Victor
AU - Brito de Mello, Maeve
AU - Baggaley, Rachel
AU - Johnson, Cheryl C.
AU - Spielman, Erica
AU - Fairley, Christopher K.
AU - Zhang, Lei
AU - de Vries, Henry
AU - Klausner, Jeffrey
AU - Zhao, Rui
AU - Ong, Jason J.
N1 - Funding Information: This study was commissioned and funded by the World Health Organization. JJO is supported by the Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (GNT1193955). CKF is supported by an Australian NHMRC Leadership Investigator Grant (GNT1172900). Publisher Copyright: © 2023 The Authors
PY - 2023/4/1
Y1 - 2023/4/1
N2 - 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.
AB - 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.
KW - HIV
KW - PrEP
KW - Pre-exposure prophylaxis
KW - Screening
KW - Sexually transmitted infections
UR - http://www.scopus.com/inward/record.url?scp=85148947230&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ijid.2023.01.007
DO - https://doi.org/10.1016/j.ijid.2023.01.007
M3 - Article
C2 - 36690140
SN - 1201-9712
VL - 129
SP - 181
EP - 187
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
ER -