(P321) Sexually transmitted infection point-of-care testing in resource-limited settings: a formative implementation evaluation

Project: In 2018, we incorporated molecular near-POC testing for chlamydia, gonorrhea, and trichomoniasis and used SDBioline Treponemal immunochromatographic testing confirmed by rapid plasma reagin for syphilis diagnosis at the Mbarara University of Science and Technology Research Laboratory in rural southwestern Uganda. We describe a formative implementation evaluation of our encountered STI POC testing challenges as well as potential solutions using the Consolidated Framework for Implementation Research (CFIR) as a conceptual framework to inform future policy and practice.



Issue: Though the global sexually transmitted infection (STI) incidence is high, the vast majority of sexually transmitted infections (STIs) are acquired in resource-limited settings (RLS) where access to laboratory diagnostics is limited. Advances in point-of-care (POC) technology have the potential to bring STI testing to many RLS for the first time. We define POC tests as being performed near the patient and with results available to inform clinical practice. The World Health Organization (WHO) Special Programme for Research and Training in Tropical Diseases further outlines desirable POC characteristics with the REASSURED (Real-time connectivity, Ease of specimen collection and Environmental friendliness, Affordable, Sensitivity, Specificity, User-friendly, Rapid and Robust, Equipment-free, and Deliverable to end-users) criteria. Despite advantages related to immediate test-and-treat care, integrating POC testing into RLS healthcare systems can present challenges that prohibit a complete reliance on these tests.



Results: Though POC and near-POC tests are generally described as easy to use, the challenges of limited person-power, healthcare processes, limited infrastructure/resources, high costs, and quality control obstacles can impede the impact of these tests. Increased investment in operators, training, and infrastructure, restructuring healthcare systems to accommodate increased POC access, and optimizing costs are all crucial to the successful implementation of STI POC testing in RLS.



Lessons Learned: New STI POC technologies should be developed with strong consideration of the POC implementation context. We have an opportunity to incorporate the lessons from HIV POC testing and leverage the technological advancements from SARS-CoV-2 POC testing, towards STI POC testing. Expanded STI POC testing in RLS will increase access to accurate diagnoses, appropriate treatment, and engage in partner notification, treatment, and prevention efforts.