Two recent studies presented at the Conference on Retroviruses and Opportunistic Infections highlight novel approaches to combat rising STI rates.
The annual Conference on Retroviruses and Opportunistic Infections (CROI) recently took place in Seattle Washington, from March 4-7, 2019. Two studies presented at the conference investigated novel ways to fight the increasing incidence of sexually transmitted infections (STIs) among high risk populations, such as men who have sex with men (MSM) and those with HIV. The first study in France showed that free postal self-sampling kits provided to high risk MSM were attractive, feasible, and identified high rates of chlamydia and gonorrhea. The second was conducted in England, and showed that partner notification using an electronic tool increased partner testing, as well as STI diagnosis and treatment.
New Strategies to Improve STI Screening.1 French guidelines recommend annual HIV testing in high-risk MSM, however, 42% of this population have not been tested in the past year. Improved testing strategies for HIV and other STIs are needed.
MemoDepistage: First Study of Free Postal Testing for STIs. Researchers conducted a multicenter, government-sponsored comprehensive STI testing program in France where they sent free STI self-sampling kits via mail to high-risk MSM. The program was advertised on same-sex dating apps and social media. The study was conducted in 4 HIV high-incidence areas with 7 testing opportunities over 18 months. The kits tested for HIV 1/2, HCV, HBV, syphilis, chlamydia, and gonorrhea.
Participants Young, Educated, Not Regularly Tested for STIs. The baseline cohort from Paris included 4220 adult MSM with ≥2 male sex partners in the past year who were HIV-negative and not in a PrEP program; this cohort accounted for 61% of the overall study. The median age was 30 years; 81% of participants had a high school diploma and 19% were college students; median number of sex partners/year was 10; 11% never tested for HIV; and 48% screened for other STIs in the past year.
High Rates of Anal Chlamydia, Oral Gonorrhea. Overall, 19% of participants tested positive for chlamydia or gonorrhea and there were 7 new HIV diagnoses. Anal chlamydia and oral gonorrhea were most common, which would not have been detected by a regular urine-only test. The preferred communication of negative results was via email (56.2%) and via phone for positive results (53.8%).
*Despite inclusion criteria for HIV negativity without PreP, some participants were HIV-positive and aware of their status such that 0.7% of samples were new HIV diagnoses.
Outcomes: STI Home Sampling Attractive, Feasible for High-risk MSM in France. The STI home self-sampling was attractive to the target population with >80 000 participants who clicked on the social media link, 60% of eligible participants who returned the sample, and the majority of kits were completed. The home sampling was feasible with >80% of samples suitable for HIV testing, ~100% of samples suitable for chlamydia/gonorrhea testing. The study will continue through December 2019 with 69% of the cohort still participating.
New Strategies to Decrease STI Transmission.2 PN aims to decrease STI transmission by notifying and treating partners, however, it is usually done by paper, mail, or phone which is time and labor intensive. SXT is a social enterprise for sexual and reproductive health providers, which uses an electronic PN tool using interactive digital contact slips. SXT sends anonymous PN via text or email and has the potential to reduce costs and increase coverage and efficiency.
First Study of Digital PN in England. Authors of a recent retrospective study in England analyzed PN initiated via SXT between December 2017 and July 2018. Authors compared PN ratio for SXT to the national data provided by PHE and examined the factors associated with successful PN. Results were adjusted for age, ethnicity, sexual orientation, self-reported gender, location of service, and STI.
Higher PN per Diagnosis with SXT vs PHE. A total of 6414 index cases initiated PN with SXT across 13 sexual health providers. The total number of diagnosed STIs was 6779 with 65% being chlamydia, 21% gonorrhea, and 5% syphilis. Per index case, 5.04% diagnosed with 2 STIs, 0.28% with 3 STIs, and 0.03% with 4 STIs. Additional diagnoses linked to SXT vs PHE over 7 months included gonorrhea (183), chlamydia (71), and syphilis (12); there was a higher PN ratio for SXT vs PHE.
Factors Associated with Not Having a Partner Tested. Factors independently linked with being less likely to have ≥1 partner tested using SXT were black vs white race; male vs female; living outside large urban area vs in urban area; online vs clinic testing; and having a partner diagnosed with trichomonas vaginalis, PID/epididymitis, or non-gonococcal urethritis vs chlamydia. Also, 70% fewer partners were informed when PN was delivered via phone vs face-to-face [OR (95% CI) 0.3 (0.26-0.35)].
SXT Increased Partner Testing, STI Diagnosis and Treatment. PN with SXT exceeded national targets for chlamydia, gonorrhea, and syphilis. Workload and costs decreased with SXT with 23%-34% of PN self-verified online or in clinic. The indentified groups in need of targeted focus for PN were those living outside urban areas; participated in online testing; partner diagnosed with trichomonas vaginalis, PID/epididymitis, or non-gonococcal urethritis; MSM; black race; and men.
1. Rahib D, Delagreverie HM, Bichard I, et al. Expanding testing strategies in Paris: A free postal comprehensive STI test kit. Abstract presented at: Conference on Retroviruses and Opportunistic Infections; March 2019; Seattle, WA.
2. Oliveira AS, Bilinska J, Mohammed H, et al.
Poster presented at: Conference on Retroviruses and Opportunistic Infections; March 2019; Seattle, WA.