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Risk-based screening to identify reproductive tract infection among HIV-infected women desiring use of intrauterine contraceptives.
BMJ Sex Reprod Health. 2020 Jul 01 [Online ahead of print]BS

Abstract

BACKGROUND

Reproductive tract infections (RTIs) are a major cause of morbidity and mortality, yet RTI testing remains limited in resource-constrained settings. We assessed performance of an existing RTI risk assessment screening tool among women living with HIV (WLHIV) considering intrauterine contraceptive (IUC) use.

METHODS

We conducted a cross-sectional analysis among WLHIV screened for participation in an IUC trial in Cape Town, South Africa (NCT01721798). RTI testing included Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and bacterial vaginosis. Tool scoring was based on five separately scored criteria: (1) age under 25 years, (2) cohabitation with a partner, (3) secondary education, (4) self-reported intermenstrual bleeding and (5) number of current sexual partners and condom use frequency (score 0-5). We assessed tool performance in detecting RTI at 0 vs 1-5, 0-1 vs 2-5 and 0-2 vs 3-5 score thresholds.

RESULTS

Of 303 women, 52% (n=157) reported antiretroviral therapy use and median age was 31 years. The prevalence of any RTI was 38% (gonorrhoea=7%, chlamydia=11%, trichomoniasis=12% and bacterial vaginosis=18%) and 8% of women had multiple RTIs. Overall, 4%, 27% and 69% of women had screening tool scores of 0, 1 or 2+, respectively. At a threshold of at least one scored criterion, the tool demonstrated high sensitivities (95%-97%) but low specificities (3%-4%) for detecting any RTI. Increasing the score threshold and/or inclusion of abnormal vaginal discharge marginally improved specificity.

CONCLUSION

The prevalence of RTIs observed in this population was high, and the screening tool had no discriminatory power to detect prevalent RTIs.

Authors+Show Affiliations

Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa ntokozolangwenya@gmail.com. Centre for Infectious Diseases Epidemiology and Research, University of Cape Town, Rondebosch, Western Cape, South Africa.Global Health, Population, and Nutrition Department, FHI 360, Durham, North Carolina, USA.Department of Epidemiology & Biostatistics, City University of New York, New York, New York, USA.Department of Statistics and Biostatistics, Rutgers University, New Brunswick, New Jersey, USA.Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa. Centre for Infectious Diseases Epidemiology and Research, University of Cape Town, Rondebosch, Western Cape, South Africa.Centre for Infectious Diseases Epidemiology and Research, University of Cape Town, Rondebosch, Western Cape, South Africa.Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa. Centre for Infectious Diseases Epidemiology and Research, University of Cape Town, Rondebosch, Western Cape, South Africa.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32611546

Citation

Langwenya, Nontokozo, et al. "Risk-based Screening to Identify Reproductive Tract Infection Among HIV-infected Women Desiring Use of Intrauterine Contraceptives." BMJ Sexual & Reproductive Health, 2020.
Langwenya N, Todd CS, Jones HE, et al. Risk-based screening to identify reproductive tract infection among HIV-infected women desiring use of intrauterine contraceptives. BMJ Sex Reprod Health. 2020.
Langwenya, N., Todd, C. S., Jones, H. E., Hoover, D. R., Hu, N. C., Ronan, A., & Myer, L. (2020). Risk-based screening to identify reproductive tract infection among HIV-infected women desiring use of intrauterine contraceptives. BMJ Sexual & Reproductive Health. https://doi.org/10.1136/bmjsrh-2019-200494
Langwenya N, et al. Risk-based Screening to Identify Reproductive Tract Infection Among HIV-infected Women Desiring Use of Intrauterine Contraceptives. BMJ Sex Reprod Health. 2020 Jul 1; PubMed PMID: 32611546.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk-based screening to identify reproductive tract infection among HIV-infected women desiring use of intrauterine contraceptives. AU - Langwenya,Nontokozo, AU - Todd,Catherine S, AU - Jones,Heidi E, AU - Hoover,Donald R, AU - Hu,Nai-Chung, AU - Ronan,Agnes, AU - Myer,Landon, Y1 - 2020/07/01/ PY - 2019/10/09/received PY - 2020/05/23/revised PY - 2020/05/27/accepted PY - 2020/7/3/entrez KW - cervical screening KW - human immunodeficiency virus KW - intrauterine devices KW - sexually transmitted infections JF - BMJ sexual & reproductive health JO - BMJ Sex Reprod Health N2 - BACKGROUND: Reproductive tract infections (RTIs) are a major cause of morbidity and mortality, yet RTI testing remains limited in resource-constrained settings. We assessed performance of an existing RTI risk assessment screening tool among women living with HIV (WLHIV) considering intrauterine contraceptive (IUC) use. METHODS: We conducted a cross-sectional analysis among WLHIV screened for participation in an IUC trial in Cape Town, South Africa (NCT01721798). RTI testing included Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and bacterial vaginosis. Tool scoring was based on five separately scored criteria: (1) age under 25 years, (2) cohabitation with a partner, (3) secondary education, (4) self-reported intermenstrual bleeding and (5) number of current sexual partners and condom use frequency (score 0-5). We assessed tool performance in detecting RTI at 0 vs 1-5, 0-1 vs 2-5 and 0-2 vs 3-5 score thresholds. RESULTS: Of 303 women, 52% (n=157) reported antiretroviral therapy use and median age was 31 years. The prevalence of any RTI was 38% (gonorrhoea=7%, chlamydia=11%, trichomoniasis=12% and bacterial vaginosis=18%) and 8% of women had multiple RTIs. Overall, 4%, 27% and 69% of women had screening tool scores of 0, 1 or 2+, respectively. At a threshold of at least one scored criterion, the tool demonstrated high sensitivities (95%-97%) but low specificities (3%-4%) for detecting any RTI. Increasing the score threshold and/or inclusion of abnormal vaginal discharge marginally improved specificity. CONCLUSION: The prevalence of RTIs observed in this population was high, and the screening tool had no discriminatory power to detect prevalent RTIs. SN - 2515-2009 UR - https://www.unboundmedicine.com/medline/citation/32611546/Risk-based_screening_to_identify_reproductive_tract_infection_among_HIV-infected_women_desiring_use_of_intrauterine_contraceptives L2 - http://jfprhc.bmj.com/cgi/pmidlookup?view=long&pmid=32611546 DB - PRIME DP - Unbound Medicine ER -
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