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STIRIG Newsletter | February 2022                                                           View this email in your browser
Sexually Transmitted Infections
Research Interest Group (STIRIG)
Issue 10: August 2022

Welcome to the 10th edition of the STIRIG Newsletter!
 
In this issue we are talking about STIs in pregnancy. Curable sexually transmitted and reproductive tract infections (STIs/RTIs) in pregnancy -- including syphilis, gonorrhoea, chlamydia, trichomoniasis, and bacterial vaginosis -- adversely impact maternal, fetal, and newborn health.  Some of these outcomes for the neonates are low birthweight, being born premature, and having the maternal infection passed on to the neonate, and for the mothers can include postpartum endometriosis. An STI among pregnant women that has recently been making headlines is trichomoniasis; which is being nicknamed in the media as the ’unknown’ STI during pregnancy. Trichomoniasis and its effects on ethnic minority women in particular has been written about recently in the BBC, among other outlets. Because of this, and many other reasons, we are discussing STIs during pregnancy in this issue. 
Spotlight
 
Aiming to reduce the burden of curable sexually transmitted and reproductive tract infections (STIs/RTIs) in pregnancy
Three PhD students from the Department of Disease Control are highlighted in this edition of the STIRIG Newsletter for their research aimed at reducing the burden of curable STIs/RTIs in pregnancy in East and Southern Africa.  Their research is embedded in routine antenatal care which includes the provision of intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) as recommended by the World Health Organization (WHO) to reduce the consequences of malaria infection during pregnancy.  IPTp-SP has been shown also to protect women with curable STIs/RTIs against adverse pregnancy outcomes.  Indeed, a recent mediation analysis has shown that IPTp-SP confers greater 'non-malarial effects' than 'anti-malarial effects' against low birthweight.
 
Georgia Gore-Langton, recipient of an MRC London Intercollegiate Doctoral Training Partnership Studentship, is analysing data from IMPROVE as part of her PhD training. 
 



Mike Chaponda, is a clinician and recipient of a Commonwealth PhD Scholarship.  He is the in-country PI of ASPIRE, a three-arm randomised clinical trial that enrolled 5,436 pregnant women in Zambia between December 2019 and March 2022, that has also been designed to address the dual-burden of malaria and curable STIs/RTIs. 
 


Sumire Sorano, a clinician and WISE programme scholar in the joint PhD programme between LSHTM and Nagasaki University, is planning to carry out an evaluation of two antigen-based/enzyme-based rapid point of care tests for the diagnosis of trichomoniasis and bacterial vaginosis among pregnant women in the same facilities as the ASPIRE trial in Zambia.  She is working closely with WHO's Department of Sexual and Reproductive Health and LSHTM's WHO Collaborating Centre on STIs.



A more detailed description of the projects can be found here

IPSAZ study
In low and middle-income countries, STIs are treated using syndromic management, which has poor sensitivity and specificity, and will not identify asymptomatic infections. In recent years, simpler diagnostic platforms for STIs have been developed. However, development and evaluation of strategies for provision of diagnostic testing in LMICs are needed to inform replacement of syndromic management by diagnostic testing.
 
The IPSAZ study (Investigating Point-of-care diagnostics for Sexually transmitted infections and Antimicrobial resistance in primary care in Zimbabwe) is a PhD project led by Kevin Martin, and supervised by Rashida Ferrand, Katharina Kranzer, and Michael Marks. It is a prospective interventional study that will be conducted in three primary healthcare clinics in Harare province, Zimbabwe. The overall aim is to evaluate a strategy of point-of-care testing for STIs including chlamydia, gonorrhoea, trichomoniasis, syphilis, and Hepatitis B, with comprehensive case management including partner notification in antenatal settings. 1000 pregnant women will be recruited over a nine-month period when registering for routine antenatal care. Acceptability, feasibility, and cost-effectiveness of the testing strategy will be assessed. Gonorrhoea samples will also be cultured and tested for antimicrobial resistance (AMR), with an additional 140 men with urethral discharge recruited to supplement gonococcal samples, to support the assessment of AMR in gonorrhoea.
 
For more information and updates on the progress of this study, please visit:
https://www.thruzim.org/
 
STIRIG News and Events

STIRIG at the International Union Against Sexually Transmitted Infections (IUSTI) World Congress
Several members of STIRIG will be speaking at the IUSTI World Congress in Zimbabwe.

  1. Professor Rashida Ferrand will be speaking on - “By youth for youth” : Working meaningfully with youth to improve sexual and reproductive health. 
  2. Michael Marks will be speaking on - The end of line: AMR, genomics and novel treatment options for syphilis. He is also participating in the WHO Priority Research Questions session. 
  3. Chido Chikwari will be speaking on - Burden of STIs in vulnerable populations.
  4. Philippe Mayaud is chairing a debate entitled - Rapid diagnostic testing for STIs will make syndromic management a thing of the past.  
  5. Debbie Watson-Jones is chairing a plenary entitled  -Advances in STI vaccines and prevention
  6. Professor David Mabey will be giving the keynote address on -  Are we ready to move on from Syndromic Management of sexually transmitted infections?
IUSTI Highlights Webinar
In this webinar, Professor David Mabey will be presenting highlights from the 23rd IUSTI World Congress, feeding back on cutting-edge topics in STIs and showcasing the work presented by LSHTM researchers during the conference, demonstrating the breadth and impact of LSHTM’s research.
 
13.00 – 14.00 BST Thursday 22nd September
Speaker: Professor David Mabey, LSHTM
 
Further details and link here
Follow @STIRIG_LSHTM on Twitter

Share your views on point-of-care test integration into STI management algorithms
We would like to invite you to complete a second-round Delphi survey. The aim is for the GIFT device to be integrated into STI and BV management algorithms, with a focus on low- and middle-income countries (LMICs). 
 Please access the survey here: https://form.jotform.com/221927653855365 
The survey will take about 15-20 minutes to complete.
 Kindly send in your response by 5th September 2022 at 23:59 GMT
We also request that you kindly share this survey within your network and contacts. We want feedback from any relevant stakeholders including doctors, nurses, other health care professionals, laboratory scientists, clinic managers, health programmers, policy makers, and researchers. We want as many people as possible to complete the survey so that the results are as generalisable as possible.
Please do not hesitate to contact us if you have any questions. Eneyi Kpokiri Eneyi.Kpokiri@lshtm.ac.uk

NICE guideline on reducing transmitted infections published.
This final guideline has now been published on the NICE website. You can also find the supporting evidence, tools and resources as well as all the stakeholder comments that we received during consultation and the responses to these comments. The comments were invaluable in helping us to develop and refine the guideline. We have also produced an equality impact assessment to support the guideline. 
There is brief information about the guideline for people using services, carers and the public at ‘Information for the public’. 
The final guideline includes recommendations for research. More detail can be found in the supporting evidence. Funding is available from the National Institute for Health and Care Research (NIHR) for projects addressing NICE research recommendations. We encourage researchers to apply for funding to generate new evidence to inform future NICE guidance.

 
STI Resources
The STIRIG resource webpage has links for STI-related guidelines, trainings, conferences, professional societies and more.
 
Featured Publications

1 Alonso, S. et al. Reduced Placental Transfer of Antibodies Against a Wide Range of Microbial and Vaccine Antigens in HIV-Infected Women in Mozambique. Frontiers in Immunology 12, doi:10.3389/fimmu.2021.614246 (2021).

2 Batura, N. et al. Point-of-care testing and treatment of sexually transmitted and genital infections during pregnancy in Papua New Guinea (WANTAIM trial): protocol for an economic evaluation alongside a cluster-randomised trial. Bmj Open 11, doi:10.1136/bmjopen-2020-046308 (2021).

3 Chaponda, E., Chico, R., Bruce, J., Michelo, C. & Chandramohan, D. THE BURDEN OF HIV ON MALARIA AND SEXUALLY TRANSMITTED AND REPRODUCTIVE TRACT INFECTIONS AMONG PREGNANT WOMEN OF RURAL, ZAMBIA. Sexually Transmitted Infections 97, A117-A117, doi:10.1136/sextrans-2021-sti.307 (2021).

4 Chaponda, E. B., Bruce, J., Michelo, C., Chandramohan, D. & Chico, R. M. Assessment of syndromic management of curable sexually transmitted and reproductive tract infections among pregnant women: an observational cross-sectional study. Bmc Pregnancy and Childbirth 21, doi:10.1186/s12884-021-03573-3 (2021).

5 Choko, A. T. et al. Partner-delivered HIV self-test kits with and without financial incentives in antenatal care and index patients with HIV in Malawi: a three-arm, cluster-randomised controlled trial. Lancet Global Health 9, E977-E988 (2021).

6 Isara, A. & Baldeh, A. K. Prevalence of sexually transmitted infections among pregnant women attending antenatal clinics in West Coast Region of The Gambia. African Health Sciences 21, 585-592, doi:10.4314/ahs.v21i2.13 (2021).

7 Kebaya, L. M. N. et al. Efficacy of Mobile phone use on adherence to Nevirapine prophylaxis and retention in care among the HIV-exposed infants in prevention of mother to child transmission of HIV: a randomized controlled trial. Bmc Pediatrics 21, doi:10.1186/s12887-021-02660-w (2021).

8 Li, C. C. et al. Prevalence of Chlamydia trachomatis Among Pregnant Women, Gynecology Clinic Attendees, and Subfertile Women in Guangdong, China: A Cross-sectional Survey. Open Forum Infectious Diseases 8, doi:10.1093/ofid/ofab206 (2021).

9 Marston, M., Risher, K. & Mahy, M. I. HIV acquisition in pregnancy: implications for mother-to-child transmission at the population level in sub-Saharan Africa. Journal of the International Aids Society 24, doi:10.1002/jia2.25783 (2021).

10 Rodriguez, P. J. et al. Cost-effectiveness of dual maternal HIV and syphilis testing strategies in high and low HIV prevalence countries: a modelling study. Lancet Global Health 9, E61-E71, doi:10.1016/s2214-109x(20)30395-8 (2021).

11 Simpson, N. et al. Insaka: mobile phone support groups for adolescent pregnant women living with HIV (vol 21, 663, 2021). Bmc Pregnancy and Childbirth 21, doi:10.1186/s12884-021-04232-3 (2021).

12 Watt, M. H. et al. The development of Maisha, a video-assisted counseling intervention to address HIV stigma at entry into antenatal care in Tanzania. Evaluation and Program Planning 83, doi:10.1016/j.evalprogplan.2020.101859 (2020).

13 Watt, M. H. et al. Pilot Outcomes of Maisha: An HIV Stigma Reduction Intervention Developed for Antenatal Care in Tanzania. Aids and Behavior, doi:10.1007/s10461-020-03093-9.
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