P024 Targeted point-of-care testing compared to syndromic management of urogenital infections in rwandan women

Background Sexually transmitted and urogenital infections are typically managed by World Health Organisation (WHO)-recommended syndromic algorithms in resource-poor countries. Vaginal discharge (VDS) and lower abdominal pain (LAP) algorithms in women perform poorly. The main aim of the WISH study was to compare the performances of VDS/LAP algorithms incorporating point-of-care tests (POCTs), and of WHO syndromic algorithms, with gold standard test results. Methods At-risk Rwandan women (N=705) underwent POCTs for bacterial vaginosis (BV; vaginal pH≥5·0) and Trichomonas vaginalis (TV; OSOM) regardless of symptom-reporting. Women with a positive risk score were POC-tested for Chlamydia trachomatis and Neisseria gonorrhoeae (CT/NG; GeneXpert). Vulvovaginal candidiasis (VVC) was treated presumptively. Nucleic acid amplification tests (NAATs) were done for CT/NG, TV, BV, and VVC on everyone and were used as gold standards. Results NAAT-based prevalences were: 60/705 (8·5%) CT, 50/705 (7·1%) NG, 111/690 (16·1%) TV, 125/690 (18·1%) BV, and 59/690 (8·6%) VVC. Infection-specific sensitivities of the WHO VDS/LAP algorithms ranged from 58·3–74·6%, and specificities from 44·7–50·6%. WISH POCT-based algorithms had good sensitivity (68·5–76·0%) and specificity (97·4–100%) for CT, NG, and TV but low specificity for BV (41·2%; sensitivity 95·2%), and modest sensitivity (64·4%) and specificity (69·4%) for VVC. Sensitivity (73·6%) and specificity (100%) for BV improves by screening all women for vaginal pH, and confirmatory testing of those with pH≥5·5 (n=275). Speculum/bimanual examinations by a physician had limited added value (except in the case of LAP), and partner notification was suboptimal. Staff and participants considered POC testing feasible and acceptable. Conclusion POC testing for urogenital infections in women improves performance and is feasible in resource-poor settings. The WHO VDS/LAP algorithms should therefore recommend POC testing whenever feasible. However, programmes would benefit from more affordable combined CT/NG POCTs, and POCTs combining BV, TV, and VVC diagnoses. Additional studies in other populations, including low prevalence populations, are warranted. Disclosure No significant relationships.