Confronting Inequities in STI Prevention, Diagnostics and Care

Conference Programme

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13:00–14:00 IUSTI Executive Committee
Lunch and Networking
Gwayi Conference Room
14:00–18:00

IUSTI Executive Committee Meeting

Venue: Gwayi Conference Room
19:00hrs IUSTI President’s Dinner
(Victoria Falls Hotel)
IUSTI-EUROPE STI Course:
Diagnosis and Management of STIs: from best practice to practical availability.
In cooperation with IUSTI-World and World Health Organization.
Venue: Gwayi Conference Room		 Hosted by Connie Celum
INSIGHT Study Investigators Meeting
Venue: Kalundu Conference Room
SESSION 1 – DIVERSITY OF STIs: THE AFRICAN AND GLOBAL VIEW
Chairs: Jo-Anne Dillon & Charlotte Gaydos
08:00-08:15 Welcome and Introduction – Angelika Stary & Marco Cusini
08:15-08:35 Epidemiology of STIs in Africa/MENA: is there a difference to other regions? – Francis Ndowa 09:00-10:30 Session I
08:35-08:55 Global impact of COVID-19 on STIs – Bradley Stoner 10:30-11:00 Refreshments Break
08:55-09:35 New and emerging causes of proctitis in MSM: lymphogranuloma venereum & monkeypox (MPXV) – Henry De Vries 11:00-12:30 Session II
12:30-13:30 Lunch
09:35-09:45 STI diagnostic practices in Asia – Somesh Gupta
09:45-09:55 STI diagnostic practices in Africa – Amina Hanҫali
09:55-10:20 Questions and discussion
10:20-10:50 Coffee break
SESSION 2 – MANAGMENT OF RECURRENT AND PERSISTENT STIs
Chairs: Janet Wilson & Jackie Sherrard
10:50-11:10 Managing NGU without access to M. genitalium and/or C. trachomatis testing – Kees Rietmeijer
11:10-11:30 Managing gonorrhoea that persists following ceftriaxone treatment – David Lewis
11:30-11:35 Neisseria but not gonorrhoea: case report – Angelika Stary
11:35-12:05 Managing vaginal discharge in settings with minimal resources  – Remco Peters
12:05-12:10 Recurrent vaginal discharge: case report – Janet Wilson
12:10-12:30 Managing recurrent genital herpes – Liz Foley
12:30-13:00 Questions and discussion
13:00-14:00 Lunch break
SESSION 3 – MANAGEMENT GUIDELINES:
Syphilis and Joint Session with WHO
Chairs: Teodora Wi & Francis Ndowa
14:30-15:00 Overview of the WHO STI guidelines for symptomatic STIs – Teodora Wi (WHO, Switzerland)
15:00-15:10 Genital Ulcer Disease Management – David Lewis (Western Sydney Sexual Health Center, and University of Sydney, Australia)
15:10-15:25 Implementation Considerations -Philippe Mayaud (London School of Hygiene and Tropical Medicine, UK)
15:25-15:40 Laboratory Considerations – Magnus Unemo (Orebro University, Sweden and WHO Collaborating Centre for STIs)
15:40-15:50 Perspectives from Health Care Provider – Anna Machiha (National STI Programme, Zimbabwe) & Van Thi Thuy Nquyen ( WHO, Vietnam)
15:50-16:00 Questions and discussion
17:00-18:30 Opening Ceremony
Chairperson: Evaristo Marowa
Venue: Kalala Conference Room
1. Welcome by the Master of Ceremonies
2. Welcome to Victoria Falls – Security briefing
3. Welcome Remarks by Conference Co-Presidents of the Conference
4. Guest of Honour – Remarks
5. Keynote Address – Meg Doherty – World Health Organization
6. Vote of thanks by Co-Chairperson
7. Last words of welcome by the Master of Ceremonies
19:00-21:00 Welcome Reception
(Pooldeck)
08:30-10:00 Plenary 1: STIs in key and vulnerable populations
Chairpersons: Laith Abu-Raddad, Angelica Espinosa Miranda
Venue: Kalala Conference Room
Speaker: Ghina Mumtaz (Lebanon). Epidemiology of STIs among refugees and displaced persons
Speaker: Rashida Ferrand (Zimbabwe). “By youth for youth” : Working meaningfully with youth to improve sexual and reproductive health
Speaker: Henry de Vries (Netherlands). Strategies to scale up HIV/STI PrEP for key populations (sex workers, MSM). [Click for more details]
10:00-10:30 Refreshments Break
10:30-12:00 Symposium 1
Antimicrobial resistance and vaccines
Chairpersons: Bradley Stoner, Fortunate Machingura
Venue: Kalala Conf Rm
View programme		 Symposium 2
Addressing STIs in Pregnancy
Chairpersons: Barbara van der Pol; Chelsea Morroni
Venue: Gwayi Conf Rm
View programme		 Symposium 3
WHO-sponsored
Venue: Kalundu Conf Rm
Increasing challenges of STIs: The need
to act now
12:00-13:30 Lunch break Symposium 4
WHO-sponsored
Venue: Kalundu Conference  Room
WHO STI Research Priority Setting and Monkeypox
13:30-15:00

Plenary 2: Understanding STIs: from basic biology to prevention
Chairpersons: Jo-Anne Dillon, Henry De Vries
Venue: Kalala Conference Room
Speaker: Jo-Ann Passmore (South Africa). Genital microbiome, inflammation, STIs and HIV prevention
Speaker: Kate Seib (Australia). Gonococcal virulence factors and vaccine development.
Speaker: Odile Harrison (UK). Informing on bacterial STIs through pathogen genomics.

[Click for more details]
15:15-16:00 Debate 1: Mathematical models are useless in predicting antimicrobial resistance in STIs
Chairperson: Nicola Low
Venue: Kalala Conference Room
For the motion: Yonatan Grad (USA)
Against the motion: Katy Turner (UK)
16:00-16:30 Refreshments Break
16:30-18:00 Poster viewing
Residents Hall/Falls View		 Symposium 5 Sponsored Session
16:30-18:00
Venue: Gwayi Conference Room
Sponsored by: The Health Research Unit Zimbabwe at BRTI
The STICH TRIAL – Disclosing results of the STI management trial for youth in Harare and Bulawayo
19:00-22:00 Speakers Dinner
Victoria Falls Safari Lodge
(by invitation only)		 Dinner in Elephant Hills Hotel Restaurant
07:00-08:30 FIND Sponsored Breakfast Session I
Venue: Kalundu Conference Room
Challenges and opportunities for addressing Neisseria gonorrhoeae Antimicrobial Resistance
08:30-10:00 Plenary 3: New diagnostics and therapeutics for STIs
Chairpersons: Charlotte Gaydos, Remco Peters
Venue: Kalala Conference Room
Speaker: Yuka Manabe (USA). Existing point-of-care tests and future developments for diagnosis and antimicrobial resistance testing
Speaker: Michael Marks (UK). The end of line: AMR, genomics and novel treatment options for syphilis
Speaker: Jonathan Ross (UK). Beyond cephalosporins – what are the options for managing N. gonorrhoeae?
10:00-10:30 Refreshments Break
10:30-12:00 Symposium 6
LATE BREAKERS
Chairperson: Angelika Stary; Yaw Ardu-Sarkodie
Venue: Kalala Conf Rm
View programme		 Symposium 7
Burden of STIs in vulnerable populations
Chairpersons: Carmen Logie; Chido Dziva Chikwari
Venue: Gwayi Conf Rm
View programme		 Symposium 8
Vaginal biology and microbiome
Chairpersons: Ellen Kersh; Jo-Ann Passmore
Venue: Matetsi Rm
View programme		 Symposium 9: WHO Sponsored Session
Venue: Kalundu Conf Rm
“Don’t let the opportunity pass: including STI services for people on HIV PrEP”
12:00-13:30 Lunch break WHO Symposium 10
Venue: Kalundu Conference  Room
The role of brief behavioural interventions in a combination prevention approach to sexually transmitted infections, including HIV: current achievements, challenges and way forward		 CANCELLED – Symposium 11
Hologic Sponsored Session
Harnessing HIV diagnostic infrastructure to address the burden of sexually transmitted infections in Africa
Venue: MatetsiVenue: Matetsi Room
13:30-15:00 Plenary 4: Addressing inequalities to STI care
Chairpersons: David Lewis; Ivana Božičević
Venue: Kalala Conference Room
Speaker: Nicola Lowe (Switzerland). Epidemiology and transmission of monkeypox
Speaker: LaRon Nelson (USA). Community engagement and inequities in STI services, including HIV: transformative visions for future
Speaker: Frances Cowan (Zimbabwe/UK). Implementation science & Integration of services for STIs and HIV. [Click for more details]
15:15-16:00 Debate 2: Rapid diagnostic testing for STIs will make syndromic management a thing of the past
Chairperson: Philippe Mayaud
Venue: Kalala Conference Room
For the motion: Jeff Klausner (USA)
Against the motion: David Lewis (Australia)
16:00-16:30 Refreshments Break
16:30-18:00 Poster viewing
Residents Hall/Falls View		 Symposium 12: WHO Sponsored Session
Venue: Kalundu
WHO HHS: Triple Elimination: Addressing STI towards the elimination of new paediatric HIV and Hepatitis B and Congenital Syphilis (EMTCT)
19:00-22:00 Congress Gala Dinner
Boma Restaurant (Shuttle Buses)
07:00-08:30 Program Science Initiative: Sponsored Breakfast Session II: Improving the effectiveness of HIV/STI prevention and treatment in sub-Saharan Africa through Program Science
Venue: Kalundu Conference  Room
08:30-10:00 Plenary 5: Advances in STI vaccines and prevention
Chairpersons: Deborah Watson-Jones, Sami Lynne Gottlieb
Venue: Kalala Conference Room
Speaker: Carolyn Deal (USA). Priorities in STI and HIV vaccines – product development and considerations for access in LMICs
Speaker: Nelly Mugo (Kenya). Access to HPV vaccination – progress towards elimination of cervical cancer in LMICs
Speaker: Linda-Gail Bekker (South Africa). A Double Dividend: Multi-purpose technology for HIV and STIs [Click for more details]
10:00-10:30 Refreshments Break
10:30-12:00 Symposium 13
Advances in diagnostics
Chairpersons: Magnus Unemo; Dumisile Venessa Maseko
Venue: Kalala Conf Rm
View Programme		 Symposium 14
Engaging diverse communities in care
Chairpersons: Margaret Pascoe; Elizabeth Foley
Venue: Gwayi Conf Rm
View Programme		 Symposium 15
Integration of STI care in PrEP services
Chairpersons: Saiqa Mullick; Marc Steben
Venue: Kalala Conference Room
View Programme
12:15-13:30 Closing Ceremony
Chairpersons: Janet Wilson; Francis J Ndowa
1. Master of Ceremonies
2. Keynote address: David Mabey, (London School of Hygiene and Tropical Medicine, UK). Are we ready to move on from Syndromic Management of sexually transmitted infections? [Click for more details]
3. Closing remarks by Co-Presidents of the Conference
13:30-15:00 Buffet Lunch
(Pooldeck)
Strategies to scale-up HIV/STI PrEP for key populations (sex workers, transgender persons, MSM)
Henry J. C. de Vries

Affiliations
– Amsterdam UMC location University of Amsterdam, Department of Dermatology, Meibergdreef 9, Amsterdam, Netherlands
– Amsterdam Institute for Infection and Immunology, Infectious Diseases, Amsterdam, The Netherlands
– Center for Sexual Health, Department of Infectious Diseases, Public Health Service Amsterdam, The Netherlands

Body
Pre-Exposure Prophylaxis against HIV transmission (PrEP) is highly effective to prevent HIV transmission in key populations such as men who have sex with men (MSM) and transgender persons (TGP). A point to consider when scaling up STI testing of PrEP users is the increased antibiotic consumption that could induce antimicrobial resistance. Moreover, since serious sequelae of gonorrhoea and chlamydia in men are rare, the optimal frequency of STI testing in asymptomatic PrEP users, cost-effectivity needs to be taken in consideration.

Key population members may feel stigmatized by the current PrEP eligibility criteria (e.g. condomless anal sex), and shunned from seeking care. Thus, focusing on HIV/STI risk might not be an effective motivator for prevention purposes. Promoting PrEP as taking control of your own health in a sex positive approach might de-stigmatize PrEP/STI care. Other points to consider are to de-silo specialized services, and integrate services in (sexual) health settings

Key Population Led Care (KPLC) is an alternative approach for Top-Down traditional services (PHS, family practice, online services). KPLC can bridge the gap between government services and key populations, especially the most marginalized communities such as TGP and sex workers. In KPLC, services are identified by the community itself and are, therefore, needs-based, demand-driven, and client-centered. Care is delivered by trained and qualified lay providers, who are often members of the key populations. Thus, KPLC could bring a solution to scale-up HIV/STI PrEP for key populations and meet the demands in an efficient, stigma free and safe care model.

Informing on bacterial STIs through pathogen genomics
Dr Odile B Harrison

Whole genome sequencing is becoming the new gold standard for the analysis and surveillance of bacterial pathogens. The decreasing costs and faster turn-around times associated with whole genome sequencing represent unrivalled opportunities to improve our ability to combat infectious diseases allowing mechanisms underlying pathogenesis to be elucidated, antimicrobial resistance determinants to be identified and improving our understanding of the epidemiology of bacterial pathogens.

In particular, whole genome sequencing (WGS) has been increasingly employed for the analysis of sexually transmitted infections caused by Neisseria gonorrhoeae with additional studies investigating WGS from Chlamydia trachomatis, Treponema pallidum subsp pallidum and Mycoplasma genitalium. This has resulted in an abundance of genome sequences for some of these species which can be exploited to further our understanding of these pathogens.

In this talk, I will demonstrate how WGS belonging to all four bacterial species can be annotated gene-by-gene and analysed online using the molecular typing and genomics platform PubMLST (https://pubmlst.org/). Using this platform, WGS are annotated in both the core and accessory genome providing a catalogue of the diversity present. I will demonstrate how these data can be mined for vaccine candidates and assessed for antimicrobial resistance determinants.

Integrating implementation science with service delivery: generating evidence for scaling up services for individuals who sell sex.
Prof Frances Cowan

In 2009 in partnership with sex workers and key stakeholders including the Ministry of Health and National AIDS Council, the Sisters with a Voice programme was established for female sex workers in Zimbabwe. Initially in five sites, the programme, guided by a series of implementation research projects, has evolved into a nationally scaled comprehensive programme for sex workers in their diversity operating in 86 sites across Zimbabwe. Over the last 14 years Sisters has provided clinical services to over 130,000 sex workers (and community services for many more). From the outset the intention was to establish the programme as an implementation-research platform to provide much needed evidence to guide HIV prevention and care for individuals who sell sex in Africa. All programme attendees have an alphanumeric ID and since 2009 have had detailed data captured at each visit (in real time electronically since 2013), allowing follow up of sex workers over time and space and in-depth analysis of programme data to guide implementation. Alongside the programme, research to inform expansion in scope and scale and to optimise efficiency and targeting of services has been undertaken. Respondent driven sampling surveys have enrolled 13,977 FSWs in 6 studies including 3 impact evaluations over 26 sites between 2011-2021. Evolution of prevention and care cascades over time and examples of research informing programme delivery will be presented.

A Double Dividend: Multi-purpose technology for HIV and STIs.
Linda-Gail Bekker

Original – Prevention options for STIs: the future of multipurpose prevention technologies – what’s new in HIV and STI prevention?

Opportunities to protect against multiple health concerns simultaneously is an attractive option for users and clinicians alike. Multipurpose technology (MPT) offers the opportunity to address more than one health issue with a single technology. MPTs, including oral, parenteral, and novel drug delivery formulations, provide the potential opportunity for a dual hit on the syndemics of HIV and STIs. This talk will address what MPTs are, describe research and development pipeline, the evidence for need and potential benefit for HIV prevention.

Are we ready to move on from Syndromic Management?
Prof. David Mabey

Until recently WHO guidelines for the management of STIs recommended syndromic management for settings without access to a diagnostic laboratory. While this undoubtedly increased access to care in resource-limited settings, it led to unnecessary treatment for infections patients did not have and failed to identify those with asymptomatic infections. In particular, the syndromic management algorithm for the management of vaginal discharge lacked both sensitivity and specificity. Even in settings with access to laboratory testing, the fact that patients needed to return for their results a few days later meant that syndromic treatment was often given at the first visit. Point of care (POC) tests which met the ASSURED criteria (Affordable, Sensitive, Specific, User friendly, Robust and Rapid, Equipment free and Deliverable) were seen as the answer to these problems.

Several POC tests for Chlamydia trachomatis were approved for clinical use in high income countries in the early 2000s but proved to be less than 50% sensitive when independently evaluated, suggesting the regulatory framework was not fit for purpose. Treponemal POC lateral flow tests for syphilis, on the other hand, were shown to meet the ASSURED criteria, and have greatly increased access to syphilis screening for pregnant women in resource-limited settings. Sensitive and specific POC tests for Trichomonas vaginalis are also available. In 2021 the FDA approved the binx io molecular POC test for Neisseria gonorrhoeae and C. trachomatis which is sensitive, specific and rapid, but it remains to be seen whether it is affordable or deliverable in low resource settings.

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