UCLA

Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis are common sexually transmitted infections (STI) worldwide, which are associated with adverse maternal and infant outcomes. Diagnostic testing accompanied by partner notification and treatment are important strategies for control of STIs. Yet most countries do not provide routine diagnostic testing for pregnant women and partner notification rates are low. While molecular diagnostics are available, the implementation costs are a barrier for many countries. This dissertation examined three aspects of efforts to address the STI burden among pregnant women in Botswana, based on a pilot point-of-care STI testing and treatment program in Gaborone.

The first study examined the prevalence and correlates of CT, NG, and TV among pregnant women receiving antenatal care and found an infection rate of 14%. HIV infection and being unmarried were associated with having an STI. Self-reported STI-related symptoms were not associated with having an STI.

The second study used qualitative interviews to assess the experiences and preferences related to partner notification among pregnant women who tested positive for an STI. The majority of women had never heard of CT, NG, or TV infections prior to testing. Thirteen out of 15 participants had notified partners about the STI diagnosis. The majority of notified partners received some treatment. Most women expressed a preference for accompanying partners to the clinic for treatment.

The third study determined costs and outcomes associated with CT and NG infection testing and treatment at an antenatal clinic. Data from this single site were modelled to estimate scale-up across Botswana according to three scenarios. Models revealed that point-of-care testing would result in the most of women cured, but at the highest cost. A centralized laboratory scenario was associated with the lowest cost, but fewer women cured. A mixed scenario had the most favorable cost per outcome.

CT, NG, and TV infections remain a significant burden among pregnant women in Botswana. Women are generally receptive to point-of-care STI testing and partner notification. Policy-makers should consider a mixed approach to scaling up STI testing and treatment to maximize population level benefits while controlling associated costs.