Integrating point-of-care screening for curable sexually transmitted infections with HIV, syphilis and hepatitis B screening in antenatal care services in Zimbabwe: a mixed-methods process evaluation

作者：Kevin Martin, Constance Mackworth-Young, Ethel Dauya, Rangarirayi Nyamwanza, Chido Dziva Chikwari, Maureen Tshuma, Joseph D. Tucker, Victoria Simms, Tsitsi Bandason, Francis Ndowa, Leolin Katsidzira, Owen Mugurungi, Anna Machiha, Remco P. H. Peters, Michael Marks, Katharina Kranzer, Rashida A. Ferrand · 发表于：BMJ Global Health · 年份：2025 · DOI：10.1136/bmjgh-2025-019820 · 被引用次数：3 · 研究领域：Reproductive tract infections research、Syphilis Diagnosis and Treatment、HIV/AIDS Research and Interventions

Introduction Sexually transmitted infections (STIs) in pregnancy are associated with adverse birth outcomes. We investigated the uptake and yield of point-of-care screening for Chlamydia trachomatis , Neisseria gonorrhoeae and Trichomonas vaginalis , integrated with HIV, syphilis and hepatitis B virus (HBV) screening in antenatal care (ANC) in Zimbabwe, and conducted a mixed-methods process evaluation of the strategy. Methods A prospective interventional study was conducted in two public-sector ANC clinics in Harare. Clients attending for ANC were screened in parallel for C. trachomatis , N. gonorrhoeae , T. vaginalis , HBV, HIV and syphilis, using four different point-of-care tests. Uptake of STI testing and treatment was recorded. Interviews and focus group discussions with pregnant women, healthcare professionals and the intervention team were conducted and analysed thematically. Implementation, mechanisms of impact and context were explored using the Medical Research Council Process Evaluation Framework. Results Between 12 January 2023 and 23 October 2023, there were 13 500 ANC attendances over 207 implementation days. Of 1105 (8.2%) assessed for eligibility, 1103 (99.8%) were eligible, of whom uptake of the full screening package was 91.0% (1004/1103). Curable STI prevalence was 30.7% (308/1003), of whom 303 (98.4%) received same-day treatment. HBV prevalence was 1.4% (14/1003). The prevalence of HIV was 10.5% (105/1003), with 20 (19.0%) being new diagnoses. Although the...