Reducing maternal and child health disparities through point-of-care STI testing in underserved populations (MATCH-POINT)

ABSTRACT The sexually transmitted infection (STI) epidemic in the United States (US) is escalating, particularly among Black and Southeastern women. Most alarmingly, syphilis cases have increased a staggering 937% and congenital syphilis cases have increased 755% in the past decade. In pregnant women, STIs can cause severe adverse reproductive health outcomes including stillbirth and preterm birth. Treatment delays for STIs are common as current test modalities do not produce same-day results. Treatment delays increase risk of onward STI transmission to others, including mother to child, and reproductive complications. Effective and scalable methods to improve timely STI treatment during pregnancy are needed to reduce extreme rates of maternal and neonatal morbidity and mortality. Point-of-care testing (POCT) for STIs may reduce treatment delays in pregnant women, but STI POCTs have not yet been implemented for this high-need population due to questions about uptake, effectiveness, implementation, and cost. Multidisciplinary experts in obstetrics, STI, clinical trials, and implementation science from Emory University propose the MATCH-POINT study, a Type 1 effectiveness-implementation randomized hybrid study to answer these critical questions. We will evaluate the impact of two highly sensitive and specific POCTs for syphilis, gonorrhea, chlamydia, and trichomoniasis on time to STI treatment among pregnant women (Aim 1). The MATCH-POINT study will also evaluate POCT implementation processes (Aim 2), costs, and cost-effectiveness (Aim 3). Study evaluation will be guided by the RE-AIM framework. This will be the first study to evaluate the impact and implementation of POCTs for these STI among pregnant women in the US; there are no US data on syphilis POCT among pregnant women, and the evidence base for gonorrhea, chlamydia, and trichomoniasis among pregnant women is extremely limited. The study will be conducted at Grady Memorial Hospital in Atlanta, Georgia. Similar to other large, safe-net hospitals in the US Southeast, Grady Memorial Hospital cares for primarily under resourced women with a high prevalence of STIs during pregnancy and high maternal and child morbidity and mortality. MATCH-POINT study findings will be used to refine STI POCT implementation strategies and make recommendations to key stakeholders at the Georgia Department of Health for scalability to under resourced pregnant women throughout the US Southeast.