Screening and treatment for Chlamydia trachomatis infection to prevent preterm birth

SUMMARY/ABSTRACT A 2023 report among UN agencies and partners found that preterm birth represents “a silent emergency” with 13.4 million babies born preterm worldwide in 2020. Preterm birth is the leading cause of infant mortality, the most important predictor of long-term morbidity, and at least 40% of preterm birth may be caused by infection. Chlamydia trachomatis (CT) is the most common curable sexually transmitted infection (STI) worldwide. Antenatal CT infection increases the risk of preterm birth, low birth weight, and vertical transmission of HIV. In low- and middle-income countries (LMIC), most CT infections persist untreated because of a lack of asymptomatic screening. Routine screening for asymptomatic antenatal CT is not recommended by the World Health Organization (WHO) because of high test costs and a paucity of data on the effectiveness of screening and treatment to prevent adverse birth outcomes. Most countries treat based on the presence of symptoms. Our previous work in Botswana identified a high prevalence of asymptomatic CT infection (23%), found that CT screening was feasible, acceptable, and contributed to a reduced post-birth CT prevalence. We found that CT screening and treatment may have reduced preterm birth compared to the standard-of-care; however, this study was not powered to find an effect on birth outcomes. We also found differential impacts by sub-groups (e.g. nulliparous women). Larger trials are urgently needed to determine the impact of asymptomatic CT screening and treatment to prevent preterm birth. This project would conduct an individually randomized- controlled trial to evaluate the impact of point-of-care screening and treatment for CT infection to prevent preterm birth among asymptomatic pregnant women in Botswana. We would also assess differential impacts among sub-groups that could be prioritized for screening. Further, we would estimate the costs of screening and treatment compared to the standard of care (syndromic management), model the budget impact of national scale-up, and examine the cost-effectiveness of screening and treating all asymptomatic pregnant women and sub-groups, compared to the standard of care.