Point-of-care diagnostics for sexually transmitted infections among migrants in Greece

TL;DR

This study compares two approaches for diagnosing and treating STIs in migrant women in Greece, finding that a test-and-treat method reduces unnecessary antibiotic use but is more expensive.

Contribution

The study evaluates the cost and impact of using a molecular diagnostic test for STIs in a migrant population, highlighting trade-offs between cost and quality of care.

Findings

Only one of 84 eligible women tested positive for chlamydia, avoiding 81 ceftriaxone/azithromycin and 19 metronidazole doses.

The test-and-treat algorithm cost €4,606.37, significantly more than the syndromic approach's €536.76.

The study advocates for cost reductions to improve the feasibility of molecular testing in resource-limited settings.

Abstract

Sexually transmitted infections (STIs) can impact individuals of any demographic. The most common pathogens causing STIs are Chlamydia trachomatis, Neisseria gonorrhea and Trichomonas vaginalis; these can be treated with specific antibiotics.

To compare the GeneXpert CT/NG test-and-treat algorithm to the syndromic approach algorithm and their impact on antibiotic prescription for gonorrhoea and chlamydia STIs.

A retrospective observational study on women aged ≥18 years who accessed the Médecins Sans Frontières Day Care Centre in Athens with complaints related to urogenital infections between January 2021 and March 2022. Women with abnormal vaginal discharge, excluding clinically diagnosed candidiasis, were eligible for Xpert CT/NG testing.

Of the 450 women who accessed care, 84 were eligible for Xpert CT/NG testing, and only one was positive for chlamydia, therefore resulting in saving 81 doses of ceftriaxone and azithromycin, and 19 doses of metronidazole. The cost of Xpert CT/NG testing, including treatment was €4,606.37, while full antibiotic treatment would have costed €536.76.

The overall cost of the Xpert CT/NG test-and-treat algorithm was higher than the syndromic approach. However, quality of care should be weighed against the potential benefits of testing and syndromic treatment to determine the best option for each patient; we therefore advocate for decreasing the costs.

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