Advancing STI Management for Migrant Populations in Greece: Leveraging Point-of-Care Diagnostics

a patient and an MSF doctor discussing during a gynecological consultation in the MSF Athens Day Care Centre.

Sexually transmitted infections (STIs) represent a significant public health concern globally, with vulnerable populations such as migrants facing heightened risks. MSF plays a crucial role in providing healthcare services to migrants, including STI management. Greece serves as a major entry point for migrants, with thousands stranded in the country due to various geopolitical factors. The conditions of migration, coupled with challenges in accessing healthcare, exacerbate the vulnerability of migrant populations, particularly concerning sexual and reproductive health (SRH) issues, including STIs.

A recent study by MSF titled "Point-of-care diagnostics for sexually transmitted infections among migrants in Greece" sheds light on the efficacy of point-of-care diagnostics in this context. The study was conducted within the scope of the 2021-2022 Antimicrobial Resistance SORT IT, with support by the MSF Luxembourg Operational Research Unit, LuxOR, and other MSF Antimicrobial Resistance (AMR) experts.

Existing Guidelines on STI Management

The World Health Organization (WHO) recommends the development and adoption of rapid testing technologies for STIs, such as the GeneXpert CT/NG System, known for its high sensitivity and specificity. However, syndromic management remains a common approach in resource-limited settings, despite its limitations in accurately diagnosing asymptomatic infections and tendency for overprescribing antibiotics. The MSF Athens Day Care Centre (DCC) uses a guided decision-making algorithm for the management of STIs (Figure 1).

Figure 1. Decision-making algorithm as per MSF guidelines

Key Findings

The study conducted employed a retrospective observational design, analysing data from women aged ≥18 years accessing DCC between January 2021 and March 2022. Among the 450 women who presented to the centre, 84 were eligible for GeneXpert CT/NG testing. Surprisingly, only one woman tested positive for chlamydia, leading to significant reductions in unnecessary antibiotic prescriptions. The study analysed the cost implications of both approaches. It was found that while the syndromic approach would have incurred a total cost of €536.76 for antibiotic treatments for the 84 women, the implementation of GeneXpert CT/NG testing resulted in savings of €489.07, primarily by avoiding unnecessary antibiotic prescriptions. On the other hand, the cost of testing for the 84 women was €4,558.68, which includes the price of consumables used (€54.27/test).

Comparing these findings with existing literature reveals compelling insights. While syndromic management remains a common practice, studies have consistently highlighted its limitations, including over prescription of antibiotics but also the underdiagnosis of asymptomatic cases who need antibiotic treatment in order to curb transmission and prevent long-term STI-related complications. The introduction of point-of-care diagnostics, such as GeneXpert CT/NG, presents a paradigm shift in STI management, enabling targeted antibiotic treatment based on precise diagnostic results.


Challenges and Implications

Despite the evident benefits of point-of-care diagnostics, challenges persist, primarily related to cost and accessibility. The high cost of GeneXpert CT/NG cartridges poses a barrier to widespread adoption, particularly in resource-limited settings. However, the long-term implications of reducing antibiotic over prescription and mitigating antimicrobial resistance underscore the importance of overcoming these challenges.

Moving forward, there is a clear imperative to integrate rapid testing technologies into STI management protocols, particularly in high-risk populations such as migrants. Collaborative efforts between healthcare providers, policymakers, and stakeholders are essential to address barriers to access and affordability. Moreover, further research and health economic evaluations are warranted to assess the cost-effectiveness of point-of-care diagnostics in diverse settings.