Optimal Deployment of Gonorrhoea Point-of-Care Tests: Modeling the Potential Impact of Diagnostic Confirmation...

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.

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.

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.

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.