Issue 9: February 2022
Welcome to the 9th edition of the STIRIG Newsletter!
In this issue, we are focusing on home- and self-testing for sexually transmitted infections (STIs). This topic has gained increasing attention recently, as the British Association for Sexual Health and HIV (BASHH) released a position statement in early 2021 on the inappropriate use of online STI test providers in the UK, raising concerns over the fact many do not meet BASHH standards for STI testing and recommending the regulation of these providers. This issue was recently picked up in an article in The Telegraph.
Home- and self-testing for STIs has become highly relevant today, particularly in the context of the COVID-19 pandemic with the increasing demand for online test providers. The availability of self-testing for STIs presents many benefits including increased accessibility, privacy, convenience and the ability to overcome significant barriers such as stigma. Potential drawbacks exist, however, with possible lack of follow-up and linkage to care, and increased health inequities for populations less likely to engage with online sexual healthcare. In this issue, we have brought together research conducted by staff across LSHTM involving home- and self-testing, highlighting studies which demonstrate opportunities for various sexually transmitted pathogens.
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Spotlight
Online STI test providers in the UK: an assessment of services available and compliance with national guidelines
Online testing for sexually transmitted infections (STIs) may contribute to overcoming barriers to traditional testing such as stigma and inconvenience. However, regulation of these tests is lacking, and the quality of services is variable, with potential short- and long-term personal, clinical and public health implications. This study, conducted by LSHTM MSc student Ellie Clarke under the supervision of Emma Harding-Esch (LSHTM), Paddy Horner, Katy Turner (University of Bristol) and Peter Muir (UKHSA South West Regional Laboratory), aimed to evaluate online tests available in the UK against national standards.
We identified providers of online STI tests (self-sampling and self-testing) in the UK through an internet search of Google and Amazon (June 2020). Website information on tests and care was collected, and further information requested from providers via an online survey, sent twice (July 2020, April 2021). The information obtained was compared to British Association for Sexual Health and HIV (BASHH) guidelines for diagnostics and standards of STI management.
We identified 31 providers: 13 self-test, 18-self-sample, and two laboratories that serviced multiple providers. Seven responded to the online survey. Many conflicts with national guidelines were identified, including: lack of health promotion information, lack of sexual history taking, use of tests licensed for professional use only marketed for self-testing, inappropriate infections tested for, incorrect specimen type used, and lack of advice for post-diagnosis management. For-profit providers were the least compliant, with concerning implications for patient care and public health. We argue that regulatory change is urgently needed to ensure that online providers are compliant with national guidelines to ensure high-quality patient care, and providers are held to account if non-compliant.
For more information on this study, please visit: https://www.medrxiv.org/content/10.1101/2021.07.01.21259784v1.full-text
Zipime Weka Schista (“Do self-testing sister”) study
Schistosoma haematobium infection in women may result in female genital schistosomiasis (FGS), a neglected gynaecological condition that occurs when Schistosoma haematobium eggs are trapped in the female genital tract. Women with FGS are at higher risk of contracting other genital and sexually transmitted infections (STIs) such as HIV, human papillomavirus (HPV), and Trichomonas vaginalis. FGS diagnosis is challenging it relies on expensive equipment and high-level specialized training that are seldom available in resource-limited settings. Innovative and more accessible diagnostics are needed to scale-up FGS surveillance given that the control of this disease may also decrease the risk of HIV and HPV and other STIs in women at risk of infection.
The Zipime Weka Schista (“Do self-testing sister”) study, led by Amaya Bustinduy at LSHTM in collaboration with colleagues at Zambart University; Kwame Shanaube and Helen Ayles among others, will address the gap in the diagnostics of FGS by integrating female sexual and reproductive health screening strategies in Zambia. The study aims to develop and implement a comprehensive approach for the diagnosis of female genital schistosomiasis (FGS) through a one-stop home self-sampling and testing screening package for FGS, HIV, HPV, and trichomoniasis and follow participants for three years. Recruitment of participants will begin in January 2022 and will take place in two areas in Zambia that are known to have Schistosoma haematobium with different levels of endemicity (ranging from <10% to >70%). Women enrolled in the study will have a home visit and one clinic visit at baseline with yearly follow up for two years. The accessibility, performance, feasibility, and cost-effectiveness of home-based genital self-sampling will be compared to the clinician obtained sampling. The study will test the hypothesis that integration of home self-sampling for the screening of multiple genital diseases in women is an acceptable, cost-effective, and self-empowering strategy that will increase the detection of cases and improve access to care for girls and women of reproductive ages in sub-Saharan Africa.
For more information and updates on the progress of this study, please visit: https://www.lshtm.ac.uk/research/centres-projects-groups/zipime-weka-schista
Syphilis Self-Testing In Zimbabwe
There are multiple barriers preventing men who have sex with men (MSM) from accessing STI testing, particularly in Zimbabwe where homosexuality is criminalised. The Zimbabwe-China syphilis self-testing project was piloted amongst MSM in Guangzhou, China and Harare, Zimbabwe. Following previous successful clinical trials to increase HIV self-testing uptake among MSM in these settings, materials and tools were developed to pilot this method of testing for syphilis. In Zimbabwe, the project is an ongoing collaboration between the London School of Hygiene and Tropical Medicine , the Pangaea Zimbabwe AIDS Trust (PZAT) and the Biomedical Research and Training Institute (BRTI) in Harare, Zimbabwe. The work is being led by Joe Tucker and Michael Marks in collaboration with Definate Nhamo, Takudzwa Mamvuto, Gwendoline Chapwanya, Imelda Mahaka, Collin Mangenah, Fern Terris-Prestholt, Clarisse Sri-Pathmanathan, Katharina Kranzer, and Rashida Ferrand.
Relevant publications include:
- Sri-Pathmanathan C, Nhamo D, Mamvuto T, et alSyphilis self-testing to expand test uptake among men who have sex with men: a theoretically informed mixed methods study in ZimbabweSexually Transmitted Infections Published Online First: 29 April 2021. doi: 10.1136/sextrans-2020-054911
- Wang C, Ong J, Zhao P, et alO06.5 Expanding syphilis test uptake using rapid dual self-testing for syphilis and HIV among MSM: a randomized controlled trial in ChinaSexually Transmitted Infections 2021;97:A29.
You can read more information here
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STIRIG News and Events
Next webinar:
“HIV prevention cascades” by Simon Gregson, Imperial College London, and colleagues from Manicaland Centre.
Thursday 28th April, 1pm GMT
STIRIG in the press!
STIRIG co-director, Emma Harding-Esch, was quoted in The Telegraph, “Antimicrobial resistance is one of the biggest challenges to STI control”, following reports of antibiotic-resistant gonorrhoea in the UK.
STIRIG co-director, Emma Harding-Esch, and steering committee member Michael Marks were both featured in a recent Economist piece about the resurgence of syphilis.
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Funding opportunities
Funding Opportunity: MRC announce a call providing up to £50,000 funding to help develop networks to improve diagnostic/surveillance tools for AMR. Closing date 14th June 2022.
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STI Resources
The STIRIG resource webpage has links for STI-related guidelines, trainings, conferences, professional societies and more.
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Featured Publications
A list of recent publications on STIs and HIV is available here
LSHTM “Featured publications” on diagnostics are:
ABOUD, L., XU, Y. Q., CHOW, E. P. F., WI, T., BAGGALEY, R., MELLO, M. B., FAIRLEY, C. K. & ONG, J. J. 2021. Diagnostic accuracy of pooling urine, anorectal, and oropharyngeal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analysis. Bmc Medicine, 19.
BASSICHETTO, K., DOURADO, I., MAGNO, L., MORAES, C. A., ROCHA, F., GOMEZ, J., CARVALHAL, L. G., DE PAULA, L. G., LUPPI, C. G., DA SILVA, M., CAIRES, P., SUZART, N. A., DA SILVEIRA, E. P. R., DE OLIVEIRA, E. L., MCCARTNEY, D., MAYAUD, P. & VERAS, M. D. M. 2021. TESTING AND TREATING SYPHILIS IN TRANSGENDER WOMEN - A POINT-OF-CARE APPROACH IN BRAZIL. Sexually Transmitted Infections, 97, A167-A167.
BATURA, N., SAWERI, O. P. M., VALLELY, A., POMAT, W., HOMER, C., GUY, R., LUCHTERS, S., MOLA, G., VALLELY, L. M., MORGAN, C., KARIWIGA, G., WAND, H., ROGERSON, S., TABRIZI, S. N., WHILEY, D. M., LOW, N., PEELING, R. W., SIBA, P. M., RIDDELL, M., LAMAN, M., BOLNGA, J., ROBINSON, L. J., MOREWAYA, J., BADMAN, S., KELLY-HANKU, A., TOLIMAN, P. J., PETER, W., PEACH, E., GARLAND, S., KALDOR, J. & WISEMAN, V. 2021. 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.
DERRICK, T. R., SANDETSKAYA, N., PICKERING, H., KOLSCH, A., RAMADHANI, A., MAFURU, E., MASSAE, P., MALISA, A., MTUY, T., BURTON, M. J., HOLLAND, M. J. & KUHLMEIER, D. 2020. DjinniChip: evaluation of a novel molecular rapid diagnostic device for the detection of Chlamydia trachomatis in trachoma-endemic areas. Parasites & Vectors, 13.
FULLER, S. S., CLARKE, E. & HARDING-ESCH, E. M. 2021. Molecular chlamydia and gonorrhoea point of care tests implemented into routine practice: Systematic review and value proposition development. Plos One, 16, e0259593.
KELLY, H. A., CHIKANDIWA, A., SAWADOGO, B., GILHAM, C., MICHELOW, P., LOMPO, O. G., OMAR, T., ZAN, S., MAGOOA, P., SEGONDY, M., NAGOT, N., MEDA, N., DELANY-MORETLWE, S., MAYAUD, P. & GRP, H. S. 2021. Diagnostic accuracy of cervical cancer screening and screening-triage strategies among women living with HIV-1 in Burkina Faso and South Africa: A cohort study. Plos Medicine, 18.
MAAN, I., LAWRENCE, D. S., TLHAKO, N., RAMONTSHONYANA, K., MUSSA, A., WYNN, A., MARKS, M., RAMOGOLA-MASIRE, D. & MORRONI, C. Using a dual antibody point-of-care test with visual and digital reads to diagnose syphilis among people living with HIV in Botswana. International Journal of Std & Aids.
MARCUS, U., MIRANDOLA, M., SCHINK, S. B., GIOS, L. & SCHMIDT, A. J. 2021. Changes in the prevalence of self-reported sexually transmitted bacterial infections from 2010 and 2017 in two large European samples of men having sex with men-is it time to re-evaluate STI-screening as a control strategy? Plos One, 16.
MARKS, M. & HARDING-ESCH, E. 2021. Antimicrobial Resistance in Gonorrhea: Diagnostics to the Rescue. Clinical Infectious Diseases, 73, 304-305.
MURTAGH, M., BLONDEEL, K., PEELING, R. W., KIARIE, J. & TOSKIN, I. 2021. The relevance of target product profiles for manufacturers, experiences from the World Health Organization initiative for point-of-care testing for sexually transmitted infections. Archives of Public Health, 79.
ONG, J. J., FU, H. Y., BAGGALEY, R. C., WI, T. E., TUCKER, J. D., SMITH, M. K., RAFAEL, S., FALCONER, J., TERRIS-PRESTHOLT, F., MAMELETZIS, I. & MAYAUD, P. 2021. Missed opportunities for sexual transmitted infections testing for HIV pre-exposure prophylaxis users: a systematic review. Journal of the International Aids Society, 24.
RODRIGUEZ, P. J., ROBERTS, D. A., MEISNER, J., SHARMA, M., OWIREDU, M. N., GOMEZ, B., MELLO, M. B., BOBRIK, A., VODIANYK, A., STOREY, A., GITHUKA, G., CHIDARIKIRE, T., BARNABAS, R., BARR-DICHIARA, M., JAMIL, M. S., BAGGALEY, R., JOHNSON, C., TAYLOR, M. M. & DRAKE, A. L. 2021. 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.
SAWERI, O. P. M., BATURA, N., AL ADAWIYAH, R., CAUSER, L. M., POMAT, W. S., VALLELY, A. J. & WISEMAN, V. 2021. Economic evaluation of point-of-care testing and treatment for sexually transmitted and genital infections in pregnancy in low- and middle-income countries: A systematic review. Plos One, 16.
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Submitting a grant application?
We'd love to hear from you
If you have applied for, or won, a grant award related to STI research, please do let us know. We'd love to hear from you so that we can celebrate the hard work of our members. You can email us at: STIRIG@lshtm.ac.uk
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