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

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.