Bring the GeneXpert’s costs down to 5 dollars: new supporting evidence

A recent study by the MSF's Athens Day Care Centre project and LuxOR highlights the importance of affordable Point-of-Care Diagnostics for the Management of Sexually Transmitted Infections 

Sexually transmitted infections (STIs) are a significant health concern worldwide, particularly for vulnerable populations like migrants who often face barriers in accessing healthcare. Médecins Sans Frontières (MSF) has been at the forefront of providing essential healthcare services to migrants, including STIs management. In light of the challenges posed by expensive testing for STIs and other diseases in the contexts in which it operates, MSF has recently launched a campaign to advocate for affordable GeneXpert tests, aiming to make diagnostics more accessible to those in need.

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Point-of-Care Diagnostics for the management of STIs at the Day Care Centre in Athens

Since 2016, MSF has been running an outpatient Day Care Centre in Athens (DCC), providing a wide range of multidisciplinary services to migrants, asylum-seekers, refugees, and other marginalized individuals requiring healthcare assistance. Greece serves as a major entry point for migrants, with thousands stranded due to geopolitical issues. Migration conditions, coupled with healthcare access challenges, heighten vulnerability to sexual and reproductive health (SRH) issues, including STIs. 

STIs diagnosis remains a challenge in many of the settings in which MSF operates. While the World Health Organization (WHO) recommends rapid testing technologies like the GeneXpert CT/NG System for STIs due to their accuracy, many resource-limited settings still rely on symptom-based treatment. DCC employs a step-by-step flow chart guide to diagnose and treat STIs, ensuring appropriate management for each case.

A recent study by MSF sheds light on the effectiveness of point-of-care diagnostics in this context. Conducted with LuxOR’s support through the Antimicrobial Resistance SORT IT (Structured Operational Research Training Initiative), the study examines STIs management among migrants in Greece.

Key Findings

The study analysed data from women aged ≥18 years accessing DCC with urogenital symptoms between January 2021 and March 2022. Out of 450 women who presented to the centre, 84 underwent GeneXpert CT/NG testing, based on an evaluation of their symptoms and STIs risk assessment. Remarkably, only one woman tested positive for chlamydia, resulting in a notable decrease in unnecessary antibiotic prescriptions. In fact, if testing were not available, all the 84 patients would have got antibiotic treatment for chlamydia. 

Additionally, the study examined the cost implications of both testing and syndromic management approaches. While the total cost for antibiotic treatment of the tested 84 women was €47.60, relying solely on symptom-based diagnosis would have amounted to €536.76. However, it's crucial to note that the cost of testing for the 84 women amounted to a total of €4,558.68.

Challenges and Implications

Besides the clinical benefits of accurate diagnosis, the rationalisation of antibiotic prescriptions is a fundamental pillar of the fight against the spread of antimicrobial resistance. As we strive for healthcare equity and improved health outcomes for all, the importance of affordable STI testing cannot be overstated. MSF's campaign serves as a rallying call to action, urging GeneXpert producer Cepheid to prioritize accessible diagnostics. By supporting initiatives for affordable testing and leveraging evidence-based research, we can make significant strides in the fight against STIs and ensure that no one is left behind in accessing essential healthcare services.