Determining the screening frequency for sexually transmitted infections for people who use HIV pre-exposure prophylaxis: a systematic review and meta-analysis

• Published in: International journal of infectious diseases Vol. 129; pp. 181 - 187
• Main Authors: Kim, Cham-mill, Zhao, Victor, Brito De Mello, Maeve, Baggaley, Rachel, Johnson, Cheryl C., Spielman, Erica, Fairley, Christopher K., Zhang, Lei, de Vries, Henry, Klausner, Jeffrey, Zhao, Rui, Ong, Jason J.
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.04.2023; Elsevier
• Subjects: Chlamydia Infections - epidemiology; Gonorrhea - diagnosis; Gonorrhea - epidemiology; Gonorrhea - prevention & control; HIV; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Infections - prevention & control; Homosexuality, Male; Humans; Male; Pre-Exposure Prophylaxis; PrEP; Screening; Sexually Transmitted Diseases - diagnosis; Sexually Transmitted Diseases - epidemiology; Sexually Transmitted Diseases - prevention & control; Sexually transmitted infections; Syphilis - diagnosis; Syphilis - epidemiology; Syphilis - prevention & control; Screening; PrEP; HIV; Pre-exposure prophylaxis; Sexually transmitted infections
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2023.01.007

•Screening for sexually transmitted infections (STIs) for pre-exposure prophylaxis users is recommended.•Lower positivity for chlamydia and gonorrhea (comparing 4-6 with 2-3 monthly screening).•No difference in syphilis positivity (comparing 4-6 with 2-3-monthly screening).•Increased STI testing could reduce STI incidence.•Need to consider feasibility and impact on gonococcal antimicrobial resistance. Although the World Health Organization recommends ‘frequent’ screening of sexually transmitted infections (STI) for people who use pre-exposure prophylaxis for HIV, there is no evidence for optimal frequency. We searched five databases and used random-effects meta-analysis to calculate pooled estimates of STI test positivity. We narratively synthesized data on secondary outcomes, including adherence to recommended STI screening frequency and changes in STI epidemiology. Of 7477 studies, we included 38 for the meta-analysis and 11 for secondary outcomes. With 2-3 monthly STI screening, the pooled positivity was 0.20 (95% confidence interval [CI]: 0.15-0.25) for chlamydia, 0.17 (95% CI: 0.12-0.22) for gonorrhea, and 0.07 (95% CI: 0.05-0.08) for syphilis. For chlamydia and gonorrhea, the positivity was approximately 50% and 75% lower, respectively, in studies that screened 4-6 monthly vs 2-3 monthly. There was no significant difference in the positivity for syphilis in studies that screened 4-6 monthly compared to 2-3 monthly. Adherence of clients to recommended screening frequency varied significantly (39-94%) depending on population and country. Modeling studies suggest more frequent STI screening could reduce incidence. Although more frequent STI screening could reduce delayed diagnoses and incidence, there remain significant knowledge gaps regarding the optimal STI screening frequency.