Feasibility of integrating the GeneXpert CT/NG assay, the OSOM Trichomonas Test into the STI diagnostic algorithm at the Mbare Adolescent Corner
Study design
Cross-sectional study
Context
Sexually transmitted infections (STIs) are a major global public health concern, particularly affecting adolescents who often face significant barriers to accessing testing and treatment. This issue is especially pronounced in Sub-Saharan Africa, including Zimbabwe, where a 2020–2022 survey across 16 communities found that 20% of young people tested positive for at least one curable STI. Untreated STIs can lead to serious health complications such as reproductive health issues, increased risk of HIV transmission, and other long-term consequences, particularly in low-and middle-income countries where healthcare access is limited. In Zimbabwe, STI diagnosis follows national guidelines, which align with World Health Organization (WHO) recommendations for syndromic management. This approach enables nurses to diagnose and treat based on symptoms without laboratory tests. However, syndromic management has limitations, as it depends on the presence of symptoms. More than 70% of curable STIs are asymptomatic and therefore remain undiagnosed and untreated, contributing to continued transmission and hindering control efforts. For instance, 70–80% of urogenital Chlamydia trachomatis (CT) infections, 30–50% of Neisseria gonorrhoeae (NG) infections, and 60–85% of Trichomonas vaginalis (TV) infections show no symptoms. Given these challenges, there is a critical need for research that not only assesses STI prevalence among adolescents in Zimbabwe but also explores effective strategies to increase testing and treatment uptake in this vulnerable population.
Our role
Coordination
Partners
- Zimbabwean Ministry of Health
Objectives
Evaluate the operational feasibility and the added value of integrating the GeneXpert CT/NG assay, the OSOM Trichomonas Test into the STI diagnostic algorithm in adolescents presenting at the Mbare Adolescent Corner.
Methodology
This cross-sectional Diagnostique study was conducted at the Adolescent Corner of Mbare Clinic in Zimbabwe, supported by Médecins Sans Frontières (MSF), from September 11, 2023, to June 4, 2024. Adolescents aged 16–19 who visited the clinic for any reason, were sexually active in the past 12 months, and provided consent were eligible. A total of 402 participants (202 males and 200 females) were consecutively enrolled.
The initial consultation included medical and sexual history (using the Five Ps questionnaire), physical examination, rapid HIV and syphilis testing, and biological sample collection for study-specific STI tests: GeneXpert for CT and NG, and TV; OSOM for TV; and NG culture with antibiotic susceptibility testing. Safe sex counselling was also provided.
Results
The study highlights a substantial burden of STIs among adolescents attending a primary care clinic, with high prevalence of all three infections assessed: Chlamydia trachomatis (20%), Neisseria gonorrhoeae (18%), and Trichomonas vaginalis (9%). The findings also underscore the limitations of syndromic management alone in this population : Among females, 70% were overtreated and 20% missed treatment; for males, overtreatment was 55%, with 2% missed treatment.
Overall, the results point to the urgent need for expanded access to rapid and accurate diagnostic testing, better integration of test results into clinical workflows, and strengthened STI prevention and partner management strategies tailored for adolescents.
