Point-of-care management of sexual transmitted infections

This thesis is about the usability and cost-effectiveness of point-of-care (POC) testing of sexual transmitted infections (STI’s). POC testing is defined as rapid medical testing carried out by a professional at or near the site of patient care. In chapter 2 and 3 we evaluated the cost-effectiveness of light microscopic examination of Gram stained smears as a POC test for urogenital gonorrhoea and chlamydia at the STI outpatient clinic of the Public Health Service (PHS) of Amsterdam. Chapter 4 reports on the evaluation of the diagnostic performance of the leucocyte esterase test (LET), a lateral flow POC test, in the detection of urogenital chlamydia among male patients at STI outpatient clinics in Paramaribo and Amsterdam. In chapter 5 the impact of POC management on the transmission of anogenital gonorrhoea among men who have sex with men (MSM) is predicted with a mathematical modelling and cost-effectiveness study. The potential influence of POC testing on the transmission of anogenital gonorrhoea is modelled with data collected from self-reported questionnaires regarding the sexual behaviour of MSM in the period between testing and treatment.In three different POC scenarios the prevalence of gonorrhoea after five years are estimated; the costs of each scenario is calculated. In chapter 6 the results of the HIV Testing Week (HTW) 2015 in Amsterdam are described. During the HTW anonymous POC tests for HIV were offered free of charge at different locations. The analyzed outcomes are the number of (positive) tested persons, characteristics and testing history of the tested population, and the healthcare workers’ experiences and opinions concerning the HTW