Determining the screening frequency for sexually transmitted infections for people who use HIV pre-exposure prophylaxis: a systematic review and meta-analysis
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-ana...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-04-01
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| Series: | International Journal of Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971223000073 |
| _version_ | 1797868257478180864 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Cham-mill Kim |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-09T23:54:11Z |
| format | Article |
| id | doaj.art-01511c11f6964e7283192953b42e448b |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-04-09T23:54:11Z |
| publishDate | 2023-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-01511c11f6964e7283192953b42e448b2023-03-17T04:32:42ZengElsevierInternational Journal of Infectious Diseases1201-97122023-04-01129181187Determining the screening frequency for sexually transmitted infections for people who use HIV pre-exposure prophylaxis: a systematic review and meta-analysisCham-mill Kim0Victor Zhao1Maeve Brito De Mello2Rachel Baggaley3Cheryl C. Johnson4Erica Spielman5Christopher K. Fairley6Lei Zhang7Henry de Vries8Jeffrey Klausner9Rui Zhao10Jason J. Ong11Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, AustraliaFaculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, AustraliaGlobal HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, SwitzerlandGlobal HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, SwitzerlandGlobal HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, SwitzerlandGlobal HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, SwitzerlandCentral Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, AustraliaCentral Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, ChinaAmsterdam UMC location University of Amsterdam, Department of Dermatology, Amsterdam, The Netherlands; Amsterdam Institute for Infection and Immunology, Infectious Diseases, Amsterdam, The Netherlands; Center for Sexual Health, Department of Infectious Diseases, Public Health Service Amsterdam, The Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, The NetherlandsKeck School of Medicine of University of Southern California, Los Angeles, United StatesChina-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, ChinaCentral Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom; Corresponding author.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.http://www.sciencedirect.com/science/article/pii/S1201971223000073HIVPrEPPre-exposure prophylaxisSexually transmitted infectionsScreening |
| spellingShingle | 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 Determining the screening frequency for sexually transmitted infections for people who use HIV pre-exposure prophylaxis: a systematic review and meta-analysis International Journal of Infectious Diseases HIV PrEP Pre-exposure prophylaxis Sexually transmitted infections Screening |
| title | Determining the screening frequency for sexually transmitted infections for people who use HIV pre-exposure prophylaxis: a systematic review and meta-analysis |
| title_full | Determining the screening frequency for sexually transmitted infections for people who use HIV pre-exposure prophylaxis: a systematic review and meta-analysis |
| title_fullStr | Determining the screening frequency for sexually transmitted infections for people who use HIV pre-exposure prophylaxis: a systematic review and meta-analysis |
| title_full_unstemmed | Determining the screening frequency for sexually transmitted infections for people who use HIV pre-exposure prophylaxis: a systematic review and meta-analysis |
| title_short | Determining the screening frequency for sexually transmitted infections for people who use HIV pre-exposure prophylaxis: a systematic review and meta-analysis |
| title_sort | determining the screening frequency for sexually transmitted infections for people who use hiv pre exposure prophylaxis a systematic review and meta analysis |
| topic | HIV PrEP Pre-exposure prophylaxis Sexually transmitted infections Screening |
| url | http://www.sciencedirect.com/science/article/pii/S1201971223000073 |
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