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A population-specific optimized GeneXpert pooling algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae to reduce cost of molecular STI screening in resource-limited settings.
J Clin Microbiol. 2020 Jun 10 [Online ahead of print]JC

Abstract

Background:

The sexually transmitted infections (STIs) chlamydia (CT) and gonorrhea (NG) are often asymptomatic in women and undetected by syndromic management, leading to complications such as pelvic inflammatory disease, infertility, and ectopic pregnancy. Molecular testing, such as the GeneXpert CT/NG assay, is highly sensitive, but cost restraints preclude implementation of these technologies in resource-limited settings. Pooled testing is one strategy to reduce the cost-per-sample, but the extent of savings depends on disease prevalence.

Methods:

The current study describes a pooling strategy based on identification of sociodemographic and laboratory factors associated with CT/NG prevalence in a high-risk cohort of Zambian female sex workers and single mothers conducted from 2016-2019.

Results:

Factors associated with testing positive for CT/NG via logistic regression modeling included city, younger age, lower education, long-acting reversible contraception usage, Trichomonas vaginalis infection, bacterial vaginosis, and incident syphilis infection. Based on these factors, the study population was stratified into high, intermediate, and low prevalence sub-groups and tested accordingly: individually, pools of 3, or pools of 4, respectively. The cost-per-sample was reduced from US$18 to as low as US$9.43 in the low prevalence sub-group.

Conclusions:

The checklist tool and pooling approach described can be used in a variety of treatment algorithms to lower the cost-per-sample and increase access to molecular STI screening. This is particularly valuable in resource-limited settings to detect and treat asymptomatic CT/NG infections missed by traditional syndromic management.

Authors+Show Affiliations

Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329 sarah.connolly@emory.edu. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322.Zambia-Emory HIV Research Project, Lusaka, Zambia.Zambia-Emory HIV Research Project, Lusaka, Zambia.Zambia-Emory HIV Research Project, Lusaka, Zambia.Zambia-Emory HIV Research Project, Lusaka, Zambia.Zambia-Emory HIV Research Project, Lusaka, Zambia. Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322.Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322. Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322.Zambia-Emory HIV Research Project, Lusaka, Zambia. Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322.Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329. Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322.Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322. Zambia-Emory HIV Research Project, Lusaka, Zambia. Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32522828

Citation

Connolly, Sarah, et al. "A Population-specific Optimized GeneXpert Pooling Algorithm for Chlamydia Trachomatis and Neisseria Gonorrhoeae to Reduce Cost of Molecular STI Screening in Resource-limited Settings." Journal of Clinical Microbiology, 2020.
Connolly S, Kilembe W, Inambao M, et al. A population-specific optimized GeneXpert pooling algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae to reduce cost of molecular STI screening in resource-limited settings. J Clin Microbiol. 2020.
Connolly, S., Kilembe, W., Inambao, M., Visoiu, A. M., Sharkey, T., Parker, R., Wall, K. M., Tichacek, A., Hunter, E., & Allen, S. (2020). A population-specific optimized GeneXpert pooling algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae to reduce cost of molecular STI screening in resource-limited settings. Journal of Clinical Microbiology. https://doi.org/10.1128/JCM.00176-20
Connolly S, et al. A Population-specific Optimized GeneXpert Pooling Algorithm for Chlamydia Trachomatis and Neisseria Gonorrhoeae to Reduce Cost of Molecular STI Screening in Resource-limited Settings. J Clin Microbiol. 2020 Jun 10; PubMed PMID: 32522828.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A population-specific optimized GeneXpert pooling algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae to reduce cost of molecular STI screening in resource-limited settings. AU - Connolly,Sarah, AU - Kilembe,William, AU - Inambao,Mubiana, AU - Visoiu,Ana-Maria, AU - Sharkey,Tyronza, AU - Parker,Rachel, AU - Wall,Kristin M, AU - Tichacek,Amanda, AU - Hunter,Eric, AU - Allen,Susan, Y1 - 2020/06/10/ PY - 2020/6/12/entrez JF - Journal of clinical microbiology JO - J. Clin. Microbiol. N2 - Background: The sexually transmitted infections (STIs) chlamydia (CT) and gonorrhea (NG) are often asymptomatic in women and undetected by syndromic management, leading to complications such as pelvic inflammatory disease, infertility, and ectopic pregnancy. Molecular testing, such as the GeneXpert CT/NG assay, is highly sensitive, but cost restraints preclude implementation of these technologies in resource-limited settings. Pooled testing is one strategy to reduce the cost-per-sample, but the extent of savings depends on disease prevalence.Methods: The current study describes a pooling strategy based on identification of sociodemographic and laboratory factors associated with CT/NG prevalence in a high-risk cohort of Zambian female sex workers and single mothers conducted from 2016-2019.Results: Factors associated with testing positive for CT/NG via logistic regression modeling included city, younger age, lower education, long-acting reversible contraception usage, Trichomonas vaginalis infection, bacterial vaginosis, and incident syphilis infection. Based on these factors, the study population was stratified into high, intermediate, and low prevalence sub-groups and tested accordingly: individually, pools of 3, or pools of 4, respectively. The cost-per-sample was reduced from US$18 to as low as US$9.43 in the low prevalence sub-group.Conclusions: The checklist tool and pooling approach described can be used in a variety of treatment algorithms to lower the cost-per-sample and increase access to molecular STI screening. This is particularly valuable in resource-limited settings to detect and treat asymptomatic CT/NG infections missed by traditional syndromic management. SN - 1098-660X UR - https://www.unboundmedicine.com/medline/citation/32522828/A_population-specific_optimized_GeneXpert_pooling_algorithm_for_Chlamydia_trachomatis_and_Neisseria_gonorrhoeae_to_reduce_cost_of_molecular_STI_screening_in_resource-limited_settings L2 - http://jcm.asm.org/cgi/pmidlookup?view=long&pmid=32522828 DB - PRIME DP - Unbound Medicine ER -
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