Lead Researcher(s)

Kevin Martin

Funder(s)

Wellcome Trust

Partner(s)

London School of Hygiene and Tropical Medicine, Ministry of Health and Child Care, Department of Social Development, Harare City Health, Ruwa Local Board, Sally Mugabe Central Hospital, Chitungwiza Hospital, Friendship Bench

Background

Sexually transmitted infections (STIs) are associated with adverse pregnancy outcomes, such as miscarriage, stillbirth, low birthweight, and prematurity. In Zimbabwe, antenatal screening only occurs for HIV and syphilis. Other STIs are treated by syndromic management, in keeping with World Health Organization (WHO) guidance for resource-limited settings. Syndromic management has poor sensitivity and specificity, leading to considerable levels of both underdiagnosis and overtreatment. In recent years, simpler diagnostic platforms for STIs have been developed. Development and evaluation of strategies for provision of diagnostic testing in resource-limited settings are needed and the WHO has called for evidence to inform replacement of syndromic management by diagnostic testing.

Study aim(s)

To evaluate a strategy of point-of-care testing for STIs including chlamydia, gonorrhoea, trichomoniasis, syphilis, and Hepatitis B, with comprehensive case management including partner notification and hepatitis B birth dose vaccination, in antenatal settings.

Study design

Prospective, interventional, mixed methods. The study enrolled 1000 pregnant women attending two primary healthcare clinics for antenatal care, and screened for chlamydia, gonorrhoea, trichomoniasis, and hepatitis B, alongside routine HIV and syphilis screening. Testing was performed on-site at the clinic, with results and treatment available on the same day as testing. Gonorrhoea samples were also cultured and tested for antimicrobial resistance. All Identified STIs were managed comprehensively including treatment and/or referral if required according to national guidelines, and partner notification and risk reduction counselling. Hepatitis B birth dose vaccination was provided to infants whose mothers were diagnosed with hepatitis B.

Study dates

2022 – 2024