Optimal deployment of gonorrhoea point-of-care tests: modelling the potential impact of diagnostic confirmation testing and screening strategies across five priority populations in Kenya
File(s)
Published version (corrected proof)
Author(s)
Type
Journal Article
Abstract
Background
Gonorrhea treatment in sub-Saharan Africa relies on syndromic management, which has poor diagnostic performance and misses asymptomatic infections. Point-of-care tests (POCTs) could address these limitations, but anticipated supply constraints necessitate strategic allocation to maximize impact.
Methods
We developed a deterministic compartmental model of gonorrhea transmission in Kenya to evaluate allocating POCTs for diagnostic confirmation of symptomatic care attendees versus screening of routine healthcare service attendees across five priority populations: female sex workers (FSW), their male clients (CFSW), pregnant women, adolescent girls and young women, or total population men. We modeled constrained and unrestricted POCT availability during 2025–2030, and estimated infections averted relative to baseline syndromic management. Quality-adjusted life years (QALYs) gained were quantified using probability tree models.
Results
At baseline, incidence was highest among FSW (11.9 [UI: 5.7–18.6] per 100 per year) and CFSW (13.1 [6.9–24.8]), while most QALY losses (80.6% [76.1%–83.8%]) were among pregnant women and their infants. With constrained POCTs (sufficient to test 0.1% of adults annually), diagnostic confirmation averted the most transmission when among symptomatic FSW (2.1% [0.6%–5.6%] of infections) or CFSW (2.2% [0.8%–5.3%]), and the most morbidity when among symptomatic pregnant women (3.5% [1.8%–7.2%] of QALY losses). Screening averted <1% of infections or QALY losses across populations. With unrestricted POCTs, screening had larger absolute impacts but lower per-test efficiency than diagnostic confirmation.
Conclusions
Our modeling supports prioritizing diagnostic confirmation over screening, consistent with WHO guidance to strengthen etiologic diagnosis within syndromic care. Diagnostic testing among symptomatic pregnant women had the largest impact on mitigating gonorrhea-related morbidity.
Gonorrhea treatment in sub-Saharan Africa relies on syndromic management, which has poor diagnostic performance and misses asymptomatic infections. Point-of-care tests (POCTs) could address these limitations, but anticipated supply constraints necessitate strategic allocation to maximize impact.
Methods
We developed a deterministic compartmental model of gonorrhea transmission in Kenya to evaluate allocating POCTs for diagnostic confirmation of symptomatic care attendees versus screening of routine healthcare service attendees across five priority populations: female sex workers (FSW), their male clients (CFSW), pregnant women, adolescent girls and young women, or total population men. We modeled constrained and unrestricted POCT availability during 2025–2030, and estimated infections averted relative to baseline syndromic management. Quality-adjusted life years (QALYs) gained were quantified using probability tree models.
Results
At baseline, incidence was highest among FSW (11.9 [UI: 5.7–18.6] per 100 per year) and CFSW (13.1 [6.9–24.8]), while most QALY losses (80.6% [76.1%–83.8%]) were among pregnant women and their infants. With constrained POCTs (sufficient to test 0.1% of adults annually), diagnostic confirmation averted the most transmission when among symptomatic FSW (2.1% [0.6%–5.6%] of infections) or CFSW (2.2% [0.8%–5.3%]), and the most morbidity when among symptomatic pregnant women (3.5% [1.8%–7.2%] of QALY losses). Screening averted <1% of infections or QALY losses across populations. With unrestricted POCTs, screening had larger absolute impacts but lower per-test efficiency than diagnostic confirmation.
Conclusions
Our modeling supports prioritizing diagnostic confirmation over screening, consistent with WHO guidance to strengthen etiologic diagnosis within syndromic care. Diagnostic testing among symptomatic pregnant women had the largest impact on mitigating gonorrhea-related morbidity.
Date Issued
2026-03-17
Date Acceptance
2026-03-11
Citation
The Journal of Infectious Diseases, 2026
ISSN
0022-1899
Publisher
Oxford University Press (OUP)
Journal / Book Title
The Journal of Infectious Diseases
Copyright Statement
© The Author(s) 2026. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41842612
PII: 8526308
Subjects
Gonorrhoea
Kenya
diagnostic confirmation
point-of-care testing
screening strategies
syndromic management
transmission modelling
Publication Status
Published online
Coverage Spatial
United States
Article Number
jiag162
Date Publish Online
2026-03-17