The control and prevention of sexually transmitted infections in primary healthcare facilities among key and priority population in sub-Saharan Africa: A systematic review

Abstract

The syndromic management approach lacks diagnostic accuracy for asymptomatic infections, although it is the standard sexually transmitted infections (STI) treatment method. The study aimed to understand the status quo on STI control in primary healthcare (PHC) facilities among key and priority populations in sub-Saharan Africa (SSA). We registered the review on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (ID: CRD42023439416). A systematic search of published articles was done using online databases and grey literature between 2016 and 2024. The search identified 2283 studies, and 1251 were excluded, remaining with 39 eligible studies for inclusion across 15 SSA countries. Of the 39 eligible studies, 11 were conducted on laboratory-diagnostic methods, and 28 were on treatment for STIs. Laboratory-diagnostic methods, including Gene Xpert assay, nucleic acid amplification transcriptase test, and multiplex reverse transcription polymerase chain reaction, have high diagnostic accuracy, sensitivity and specificity rates. However, they may result in delayed sampled results. Eighteen studies indicate that the STI syndromic management approach remains the standard care for treatment in PHC facilities, but its challenges include drug resistance, misdiagnosis, and low sensitivity. Integrating syndromic management with laboratory-diagnostic methods can improve diagnostic accuracy and allow early identification, diagnosis and treatment of STIs. These findings aim to inform policymakers and STI stakeholders to provide scientific evidence for targeted approaches to optimise and strengthen the STI response in SSA.