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Implementation Science

Session: Reaching the Vulnerable

O2.4 - Preparedness of pregnant women to wait for same-day results of sexually transmitted infections

Tuesday, July 25, 2023
10:45 – 11:00 CST
Location: Chicago 9

    Primary Presenter(s)

  • RG

    Ranjana M S Gigi, MMed, PhD student

    MD-PhD student
    1) Institute of Social and Preventive Medicine, University of Bern, Switzerland 2) Research Unit, Foundation for Professional Development, South Africa, Eastern Cape, South Africa

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Project

We are conducting studies about sexually transmitted infections (STIs) in pregnancy in 5 primary healthcare clinics in East London, South Africa. At antenatal visits, research nurses collect a vaginal swab for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis testing on the GeneXpert platform. Women with any positive result are offered same-day treatment. Women who do not wait are telephonically requested to return for treatment. A subset was asked about their preparedness to wait for their results.

Issue

Ensuring treatment for STIs in resource-limited settings is challenging. Introduction of diagnostic testing for STIs is imperative. The GeneXpert system provides the opportunity for same-day treatment as STI test results are available within 90 minutes. However, it is not clear whether same-day treatment is feasible in clinics. In our study clinics, 2 have a designated waiting area and 3 do not.

Results

We tested 1194 pregnant women for STIs from March 2021 to December 2022, of whom 282 (24%, 95% confidence interval, CI 21-26) had positive results for any STI. Of these, 116/282 (41%) received same-day treatment, 92/282 (33%) returned within 1 week, 53/282 (19%) within 2-11 weeks, and 21 (7%) did not return. The concordance of the intention to wait/not to wait and if participants effectively waited, was 70% (99/141) among 141 women who answered additional questions. The most common reasons not to wait were (1) need to get back to family (42/121, 35%), (2) need to get to work (33/121, 27%), and (3) hunger (18/121, 15%). Combining data from all participants in random effects meta-analysis stratified by clinic (Figure 1), 91% (CI 75-97%, I2 79%) waited in clinics with a waiting room compared with 18% (CI 13-25%, I2 60%) in clinics without.

Lessons Learned

Same-day treatment for pregnant women with STIs was possible and more likely at clinics with a designated waiting area. The intention of women to wait is not a reliable indicator of actual waiting, suggesting that the intention can be modified. We have since built waiting rooms in 2 of the 3 clinics that did not have them and are studying the outcomes of this intervention on same-day STI treatment.