Assessment of the laboratory capacity for testing Sexual Transmitted Infections at 14 health facilities in Moshi Municipality, Tanzania

The global occurrence of sexually transmitted infections (STIs) continues to rise, necessitating accurate diagnosis and treatment to curb their spread and associated complications. With the alarming increase in antimicrobial resistance (AMR) in Neisseria gonorrhoeae, effective STI management relies heavily on etiological diagnosis. The Tanzania National Standard for Medical Laboratories 2017 outlines recommended STI testing protocols based on facility levels, yet adherence to these guidelines and associated challenges remain poorly documented. This study describes the diagnostic capacity for different STIs in northern Tanzania. A cross-sectional study was conducted between May and July 2023, encompassing 14 laboratories across Moshi Municipal Council, Kilimanjaro region. The laboratories assessed were in five hospitals and nine health centres (HCs). Data regarding facility type and STI diagnostic capabilities were gathered through questionnaires administered during site visits and supplemented by observations. All five hospitals were equipped to conduct rapid diagnostic tests for HIV, syphilis, and wet preparation microscopy for Trichomonas vaginalis (TV). Only three hospitals had the capacity to perform culture and sensitivity testing using chocolate and blood agar medium, however none reported isolating Neisseria gonorrhoeae in the past year. Critical STI diagnostic tests including the Treponema pallidum particle agglutination assay (TPPA) and Treponema pallidum hemagglutination assay (TPHA) for the laboratory confirmation of syphilis, assays for Chlamydia trachomatis, Herpes Simplex virus -2, and Human papillomavirus (HPV) were absent across all five hospitals. Conversely, all health centers demonstrated proficiency in rapid treponemal tests for syphilis, together with rapid HIV test and TV testing, although one health center lacked the capacity for wet laboratory preparation for TV detection. Findings underscore a concerning lack of STI testing capacity within surveyed healthcare facilities, posing significant barriers to effective STI management and exacerbating the threat of AMR in Tanzania. In particular, the capacity for conventional microbiology culture was limited in most settings, severely compromising the ability to track and monitor AMR. Urgent investment in laboratory infrastructure and training is imperative to enhance STI diagnosis and treatment, ultimately curtailing transmission and mitigating the impact of AMR.