# STI prevalence and the integration of point-of-care nucleic acid amplification testing into STI diagnostic algorithms at a Médecins Sans Frontières key population clinic in San Pedro Sula, Honduras

## TL;DR

This study shows high STI rates in Honduras and how rapid NAAT testing improves diagnosis and care for key populations.

## Contribution

The study evaluates the feasibility and impact of integrating point-of-care NAAT into STI diagnostics in a resource-limited setting.

## Key findings

- 31.8% of participants tested positive for at least one STI, with high rates of HPV, syphilis, chlamydia, and gonorrhea.
- Only 29.3% of participants and 56.6% of positive STI tests were symptomatic, highlighting the importance of asymptomatic detection.
- Clinic staff found NAAT beneficial for patient care but raised concerns about long-term sustainability.

## Abstract

Data is limited on the prevalence of sexually transmitted infections (STIs) among key populations in Honduras. Additionally, clinics largely rely on syndromic management of STIs, which has poor diagnostic performance. This study assesses STI prevalence and the feasibility and diagnostic utility of rapid nucleic acid amplification testing (NAAT) in comparison to syndromic identification among the LGBTQIA+ and sex worker community of San Pedro Sula attending a Médecins sans Frontières (MSF) clinic.

Patients attending MSF's San Pedro Sula clinic from February to June 2024, were invited to participate in the study. Clinicians assessed all participants for STI symptoms and, regardless of symptoms, collected whole blood, urine, and vaginal samples. Rapid testing [Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), Hepatitis C (HCV), and syphilis] and NAAT via GeneXpert [chlamydia, gonorrhea, trichomoniasis, and human papilloma virus (HPV)] were performed. Treatment was initially prescribed per WHO Syndromic Management Guidelines and revised following NAAT results. Descriptive statistics and diagnostic metrics were calculated. Focus groups with clinic staff assessed feasibility.

Of the 157 patients enrolled, 31.8% (n = 50) tested positive for at least one STI: HPV 19.4% (7/36), syphilis 12.1% (19/157), chlamydia 10.2% (16/157), gonorrhea 8.3% (13/157), trichomoniasis 3.8% (6/157), HIV 3.8% (6/157), HBV 0% (0/157), and HCV 0% (0/157). Of those, 38.0% (n = 19) tested positive for multiple STIs. Only 29.3% (n = 46) of all participants and 56.6% (n = 22) of positive tests for chlamydia, gonorrhea, syphilis, or trichomoniasis were symptomatic. Staff felt GeneXpert benefited patient care but were concerned about sustainability.

This study underscores the high STI prevalence among key populations in San Pedro Sula, Honduras. Results show that point-of-care NAAT implementation is beneficial, appreciated, and feasible in this context and can successfully be integrated into basic clinic diagnostics. The added testing capacity improved diagnostic and management capacity of the clinic, especially regarding asymptomatic STIs, and thus improved quality of care for key populations. A translated version of this manuscript in Spanish can be found in Supplementary Appendix S1.