背景:低收入和中等收入国家(LMIC)的性传播感染(STIs)主要通过综合征管理来管理。然而,大多数性传播感染是无症状的。这些未经治疗的性传播感染会导致个体发病,并导致高性传播感染流行率。越来越多的人对LMIC中的性传播感染使用即时护理测试(POCT)感兴趣,这可以促进同一天的测试和治疗。为了最好地利用这些测试,我们必须了解其实施的促进者和障碍。本次审查的目的是探讨如何在LMIC的医疗保健系统中实施性传播感染的护理点测试,以及促进者和障碍。
方法:通过搜索MEDLINE进行范围审查,Embase,Emcare,CINAHL,Scopus,LILACS,Cochrane图书馆,以及ProQuest论文和论文,用于1998年1月1日至2020年6月5日之间发表的研究。摘要和全文由两名审稿人独立筛选。如果研究评估了可接受性,则考虑纳入研究,可行性,主持人,或实施衣原体即时检测的障碍,淋病,LMIC中的滴虫病或梅毒。主题分析用于分析和介绍即时性传播感染测试的促进者和障碍。
结果:文献检索显示82篇适合纳入的文章;44篇(53.7%)来自撒哈拉以南非洲;21篇(25.6%)来自拉丁美洲和加勒比地区;10篇(12.2%)来自东亚和太平洋地区;6篇(7.3%)来自南亚;1篇(1.2%)多区域研究。专题分析揭示了与在低收入国家实施POCT有关的七个总体主题,即(I)理想的测试特性,(二)客户因素,(三)医疗保健提供因素,(四)政策,基础设施和卫生系统因素,(v)培训,审计,和反馈,(六)达到新的测试环境,和(vii)双重测试。
结论:在LMIC中实施POCT是复杂的,由于更广泛的卫生系统薄弱,许多障碍。除了迫切要求进行更广泛的结构变革以促进基本医疗保健的提供之外,这些主题也可以用作制定未来干预措施的基础。文献严重偏向梅毒测试,所以需要进行更多的研究来评估衣原体,淋病,和滴虫病检测,以及家庭或自我测试。
BACKGROUND: Sexually transmitted infections (STIs) in low- and middle-income countries (LMICs) are predominantly managed by syndromic management. However, most STIs are asymptomatic. These untreated STIs cause individual morbidity, and lead to high STI prevalences. There is increasing interest in the use of point-of-care tests (POCTs) for STIs in LMICs, which could facilitate same day testing and treatment. To best utilise these tests, we must understand the facilitators and barriers to their implementation. The aim of this
review is to explore how point-of-care testing for STIs has been implemented into healthcare systems in LMIC and the facilitators and barriers to doing so.
METHODS: A scoping
review was conducted by searching MEDLINE, Embase, Emcare, CINAHL, Scopus, LILACS, the Cochrane Library, and ProQuest Dissertations and Theses for studies published between 1st January 1998 and 5th June 2020. Abstracts and full articles were screened independently by two reviewers. Studies were considered for inclusion if they assessed the acceptability, feasibility, facilitators, or barriers to implementation of point-of-care testing for chlamydia, gonorrhoea, trichomoniasis or syphilis in LMICs. Thematic analysis was used to analyse and present the facilitators and barriers to point-of-care STI testing.
RESULTS: The literature search revealed 82 articles suitable for inclusion; 44 (53.7%) from sub-Saharan Africa; 21 (25.6%) from Latin American and the Caribbean; 10 (12.2%) from East Asia and the Pacific; 6 (7.3%) from South Asia; and one (1.2%) multi-regional study. Thematic analysis revealed seven overarching themes related to the implementation of POCTs in LMICs, namely (i) Ideal test characteristics, (ii) Client factors, (iii) Healthcare provision factors, (iv) Policy, infrastructure and health system factors, (v) Training, audit, and feedback, (vi) Reaching new testing environments, and (vii) Dual testing.
CONCLUSIONS: Implementation of POCTs in LMICs is complex, with many of the barriers due to wider health system weakness. In addition to pressing for broader structural change to facilitate basic healthcare delivery, these themes may also be used as a basis on which to develop future interventions. The literature was heavily skewed towards syphilis testing, and so more research needs to be conducted assessing chlamydia, gonorrhoea, and trichomoniasis testing, as well as home or self-testing.