Diagnostic accuracy of pooling urine, anorectal, and oropharyngeal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analysis

Abstract Background Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at genital and extragenital sites is needed for most key populations, but molecular diagnostic tests for CT/NG are costly. We aimed to determine the accuracy of pooled samples from multiple anatomic sites fro...

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Autores principales:	Lily Aboud, Yangqi Xu, Eric P. F. Chow, Teodora Wi, Rachel Baggaley, Maeve B. Mello, Christopher K. Fairley, Jason J. Ong
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Sexually transmitted infections Chlamydia Gonorrhoea Testing Screening Medicine R
Acceso en línea:	https://doaj.org/article/b7c7702caa87489f9a6820a99899c17c
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spelling	oai:doaj.org-article:b7c7702caa87489f9a6820a99899c17c2021-11-28T12:15:19ZDiagnostic accuracy of pooling urine, anorectal, and oropharyngeal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analysis10.1186/s12916-021-02160-91741-7015https://doaj.org/article/b7c7702caa87489f9a6820a99899c17c2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12916-021-02160-9https://doaj.org/toc/1741-7015Abstract Background Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at genital and extragenital sites is needed for most key populations, but molecular diagnostic tests for CT/NG are costly. We aimed to determine the accuracy of pooled samples from multiple anatomic sites from one individual to detect CT/NG using the testing of a single sample from one anatomic site as the reference. Methods In this systematic review and meta-analysis, we searched five databases for articles published from January 1, 2000, to February 4, 2021. Studies were included if they contained original data describing the diagnostic accuracy of pooled testing compared with single samples, resource use, benefits and harms of pooling, acceptability, and impact on health equity. We present the pooled sensitivities and specificities for CT and NG using a bivariate mixed-effects logistic regression model. The study protocol is registered in PROSPERO, an international database of prospectively registered systematic reviews (CRD42021240793). We used GRADE to evaluate the quality of evidence. Results Our search yielded 7814 studies, with 17 eligible studies included in our review. Most studies were conducted in high-income countries (82.6%, 14/17) and focused on men who have sex with men (70.6%, 12/17). Fourteen studies provided 15 estimates for the meta-analysis for CT with data from 5891 individuals. The pooled sensitivity for multisite pooling for CT was 93.1% [95% confidence intervals (CI) 90.5–95.0], I 2 =43.3, and pooled specificity was 99.4% [99.0–99.6], I 2 =52.9. Thirteen studies provided 14 estimates for the meta-analysis for NG with data from 6565 individuals. The pooled sensitivity for multisite pooling for NG was 94.1% [95% CI 90.9–96.3], I 2 =68.4, and pooled specificity was 99.6% [99.1–99.8], I 2 =83.6. Studies report significant cost savings (by two thirds to a third). Conclusion Multisite pooled testing is a promising approach to improve testing coverage for CT/NG in resource-constrained settings with a small compromise in sensitivity but with a potential for significant cost savings.Lily AboudYangqi XuEric P. F. ChowTeodora WiRachel BaggaleyMaeve B. MelloChristopher K. FairleyJason J. OngBMCarticleSexually transmitted infectionsChlamydiaGonorrhoeaTestingScreeningMedicineRENBMC Medicine, Vol 19, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Sexually transmitted infections Chlamydia Gonorrhoea Testing Screening Medicine R
spellingShingle	Sexually transmitted infections Chlamydia Gonorrhoea Testing Screening Medicine R Lily Aboud Yangqi Xu Eric P. F. Chow Teodora Wi Rachel Baggaley Maeve B. Mello Christopher K. Fairley Jason J. Ong Diagnostic accuracy of pooling urine, anorectal, and oropharyngeal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analysis
description	Abstract Background Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at genital and extragenital sites is needed for most key populations, but molecular diagnostic tests for CT/NG are costly. We aimed to determine the accuracy of pooled samples from multiple anatomic sites from one individual to detect CT/NG using the testing of a single sample from one anatomic site as the reference. Methods In this systematic review and meta-analysis, we searched five databases for articles published from January 1, 2000, to February 4, 2021. Studies were included if they contained original data describing the diagnostic accuracy of pooled testing compared with single samples, resource use, benefits and harms of pooling, acceptability, and impact on health equity. We present the pooled sensitivities and specificities for CT and NG using a bivariate mixed-effects logistic regression model. The study protocol is registered in PROSPERO, an international database of prospectively registered systematic reviews (CRD42021240793). We used GRADE to evaluate the quality of evidence. Results Our search yielded 7814 studies, with 17 eligible studies included in our review. Most studies were conducted in high-income countries (82.6%, 14/17) and focused on men who have sex with men (70.6%, 12/17). Fourteen studies provided 15 estimates for the meta-analysis for CT with data from 5891 individuals. The pooled sensitivity for multisite pooling for CT was 93.1% [95% confidence intervals (CI) 90.5–95.0], I 2 =43.3, and pooled specificity was 99.4% [99.0–99.6], I 2 =52.9. Thirteen studies provided 14 estimates for the meta-analysis for NG with data from 6565 individuals. The pooled sensitivity for multisite pooling for NG was 94.1% [95% CI 90.9–96.3], I 2 =68.4, and pooled specificity was 99.6% [99.1–99.8], I 2 =83.6. Studies report significant cost savings (by two thirds to a third). Conclusion Multisite pooled testing is a promising approach to improve testing coverage for CT/NG in resource-constrained settings with a small compromise in sensitivity but with a potential for significant cost savings.
format	article
author	Lily Aboud Yangqi Xu Eric P. F. Chow Teodora Wi Rachel Baggaley Maeve B. Mello Christopher K. Fairley Jason J. Ong
author_facet	Lily Aboud Yangqi Xu Eric P. F. Chow Teodora Wi Rachel Baggaley Maeve B. Mello Christopher K. Fairley Jason J. Ong
author_sort	Lily Aboud
title	Diagnostic accuracy of pooling urine, anorectal, and oropharyngeal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analysis
title_short	Diagnostic accuracy of pooling urine, anorectal, and oropharyngeal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analysis
title_full	Diagnostic accuracy of pooling urine, anorectal, and oropharyngeal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analysis
title_fullStr	Diagnostic accuracy of pooling urine, anorectal, and oropharyngeal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analysis
title_full_unstemmed	Diagnostic accuracy of pooling urine, anorectal, and oropharyngeal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analysis
title_sort	diagnostic accuracy of pooling urine, anorectal, and oropharyngeal specimens for the detection of chlamydia trachomatis and neisseria gonorrhoeae: a systematic review and meta-analysis
publisher	BMC
publishDate	2021
url	https://doaj.org/article/b7c7702caa87489f9a6820a99899c17c
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Diagnostic accuracy of pooling urine, anorectal, and oropharyngeal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analysis

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