Improving Sexually Transmitted Infection diagnostics and control among Men who have sex with Men in low-and high-resource settings

Project Details


To end the epidemic of sexually transmitted infections (STIs) globally by 2030, the World Health Organisation issued a global health strategy and identified five strategic directions: understanding the STI epidemic, interventions for impact, delivering for equity, finding affordable solutions and developing innovative STI diagnostic tests and testing strategies.[1] Our aim is to provide scientific evidence to all of these directions by targeting one population that is identified to be among those at most risk for STIs: men who have sex with men (MSM) and more particularly those who use Pre-exposure prophylaxis (PrEP) for HIV prevention (MSM PrEP users). In order to address the "global" aspect, we choose to perform subsequent studies in high and low-resource settings.
The landscape of HIV prevention among MSM changed dramatically thanks to the access to oral PrEP. Currently, PrEP has been implemented for HIV prevention among MSM in several high-resource countries. In Belgium, the 'Be-PrEP-ared' demonstration project played an essential role in the implementation of PrEP. Similar PrEP demonstration projects among MSM are also ongoing in Africa including four West-African countries (`CohMSM-PrEP' study in Togo, Mali, Cote d'Ivoire and Burkina Faso). [2]
PrEP decreases the risk of acquiring HIV up to 92%, yet does not prevent other STIs. In fact, recent reviews of "real-world" PrEP demonstration studies showed that PrEP is associated with increased diagnoses of STIs in MSM. [3,4] One of the cornerstones of STI control is the prompt identification and treatment of STIs in those individuals who are the most at risk for STIs, yet remaining asymptomatic. The realistically best possible approach towards STI prevention and control may differ greatly between countries depending on their resources.
The following STIs will be targeted: Chlamydia trachomatis (CT) including Lymphogranuloma venereum (LGV), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV).
The overall aim of this thesis is to contribute to the control of the STI epidemic among MSM, and in particular PrEP users, in low- and high-resource settings by focusing on two major interlinked objectives:
1. To characterize various important clinical and epidemiological aspects of above-mentioned STIs among MSM using PrEP in low- and/or high-resource settings 1.1. To document STI (CT/NG/MG/TV) prevalence and incidence 1.2. To document the LGV-component of the CT epidemic in more detail by assessing the phylogenetic characteristics 1.3. To examine the MG macrolide resistance prevalence 1.4. To assess the proportion of asymptomatic STIs (CT/NG) in West-Africa
2. To evaluate potential screening strategies in both settings in order to simplify STI testing 2.1. To evaluate the use of the point-of-care assay GeneXpert for STI testing in West-Africa 2.2. To develop sample pooling strategies for molecular testing of CT/NG as cost-effective intervention of STI screening 2.3. To evaluate home-based sampling for screening of STIs during PrEP follow-up visits
1 WHO. Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021.
World Health Organ 2016;1:63. doi:10.1055/s-2007-970201.
2 Ongoing and Planned PrEP Demonstration and Implementation Studies I AVAC. (accessed 3 Aug 2016).
3 Kojima N, Davey DJ, Klausner JD. Pre-exposure prophylaxis for HIV infection and new sexually transmitted infections among men who have sex with men. AIDS 2016;30:2251-2. doi:10.1097/QAD.0000000000001185
4 Traeger MW, Schroeder SE, Wright EJ, et al. Effects of Pre-exposure Prophylaxis for the Prevention of Human Immunodeficiency Virus Infection on Sexual Risk Behavior in Men Who Have Sex With Men: A Systematic Review and Meta-analysis. Clin Infect Dis Published Online First: 2 March 2018. doi:10.1093/cid/ciy182
Effective start/end date11/04/1913/09/21

IWETO expertise domain

  • B780-tropical-medicine


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