Quantifying geographical diversity in sexually transmitted infections using population attributable risk: results from HIV prevention trials in South Africa

2021 ◽  
pp. 095646242096899
Author(s):  
Handan Wand ◽  
Gita Ramjee ◽  
Tarylee Reddy
Keyword(s):  
South Africa ◽  
Hiv Prevention ◽  
Sexually Transmitted Infections ◽  
Population Attributable Risk ◽  
Population Level ◽  
Incidence Rates ◽  
Attributable Risk ◽  
Individual Risk ◽  
Sexually Transmitted ◽  
Prevention Trials

In this study, we investigated spatial diversities of sexually transmitted infections (STIs) and quantified their impacts on the STIs using population attributable risk (PAR%). The study population was 7,557 women who participated in several HIV prevention trials from KwaZulu-Natal, South Africa. Our results provide compelling evidence for substantial geographical diversities on STI incidence rates in the region. Their population-level impacts on the STIs exceeded the combined impacts of the individual risk factors considered in this study (PAR%: 41% (<25 years), 52% (25-34 years) and 34% (35+ years). When all these factors are considered together, PAR% was the highest among younger women (PAR%: 67%, 82% and 50% for <25, 25-34 and 35+ years old respectively). Results from our study will bring greater insight into the previous research by increasing our understanding of the impacts of the sub-geographical level variations of STI prevalence and incidence rates in the region.

scholarly journals Estimating prevalence and incidence of sexually transmitted infections among South African women: Implications of combined impacts of risk factors

2020 ◽  
Vol 31 (11) ◽  
pp. 1093-1101
Author(s):  
Handan Wand ◽  
Tarylee Reddy ◽  
Reshmi Dassaye ◽  
Jothi Moodley ◽  
Sarita Naidoo ◽  
...  
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Sexually Transmitted Infections ◽  
Sexual Debut ◽  
Population Attributable Risk ◽  
Incidence Rates ◽  
Influential Factors ◽  
African Women ◽  
Sexually Transmitted ◽  
South African Women

In addition to being the epicentre of the HIV epidemic, South Africa also has the highest burden of sexually transmitted infections (STIs) in the world. Therefore, understanding the most influential risk factors of STIs is a research priority. Using the data from 9948 women who resided in KwaZulu Natal, South Africa, we estimated the population attributable risk to quantify the combined impacts of the most influential factors on STI diagnosis. Overall STI prevalence was 20%, and STI incidence was 15 per 100 person-years. Four factors: age at sexual debut, single/not cohabiting, two or more sex partners and parity <3 were identified as the most influential risk factors for STI prevalence and incidence rates. However, these factors collectively associated with only 51% and 53% of the excess STI prevalence and incidence rates, respectively. These relatively modest impacts provide empirical evidence for the significant impacts of unmeasured factors on STIs. Culturally and socially appropriate prevention programs may be more effective to target those at highest risk of STIs.

scholarly journals The effects of the integration of an economic strengthening and HIV prevention education programme on the prevalence of sexually transmitted infections and savings behaviours among adolescents: a full-factorial randomised controlled trial in South Africa

2020 ◽  
Vol 5 (4) ◽  
pp. e002029
Author(s):  
Holly M Burke ◽  
Mario Chen ◽  
Kate Murray ◽  
Charl Bezuidenhout ◽  
Phuti Ngwepe ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Prevention ◽  
Sexually Transmitted Infections ◽  
Controlled Study ◽  
Prevention Education ◽  
Sexually Transmitted ◽  
Sexual Behaviours ◽  
Randomised Controlled ◽  
Full Factorial ◽  
Economic Strengthening

BackgroundMultisectoral approaches are thought necessary to prevent HIV among adolescents. We examined whether an economic strengthening (ES) and an HIV-prevention education intervention improved outcomes when combined versus separately.MethodsWe conducted a full-factorial randomised controlled study to randomise participants into all possible intervention groups based on the two interventions: economic strengthening only (ES-only), HIV-prevention only (HIV-only), both interventions combined (ES+HIV) and no intervention (control). We measured sexually transmitted infections (STIs), self-reported economic and sexual behaviours/knowledge, and pregnancy at a pre-intervention and two post-intervention assessments. Eligible participants were adolescents 14 to 17 years old from a programme supporting vulnerable families in Gauteng Province, South Africa. We estimated intervention effects using repeated measures, generalised linear mixed models.ResultsA total of 1773 adolescents participated (57% female). ES+HIV adolescents had the lowest STI prevalence at first endline; however, the comparison with the control was not significant (OR 0.62, 95% CI 0.27 to 1.41). ES-only or HIV-only groups were not significantly better than the control on STI prevalence (OR 1.53, 95% CI 0.73 to 3.20 and OR 1.47, 95% CI 0.69 to 3.12, respectively). STI prevalence became more similar among the groups at second endline.ES-only adolescents were more likely to participate in savings groups (p=0.004) and plan to save for education (p=0.001) versus the control. ES+HIV adolescents were more likely to plan to save for education versus the control (p=0.001) and HIV-only groups (p=0.002) but did not differ significantly from the ES-only group (p=0.803). The ES+HIV intervention’s effect on HIV knowledge was significant compared with the control (p=0.03) and ES-only groups (p<0.001), but not when compared with the HIV-only group (p=0.091). Effects on pregnancy, sexual behaviours or other economic behaviours were not significant.ConclusionsWe could not confirm the ES and HIV interventions, separately or combined, were effective to reduce STI prevalence. Evaluations of multicomponent interventions should use full-factorial designs to fully assess effects.Trial registration numberNCT02888678

scholarly journals Screening for genital and anorectal sexually transmitted infections in HIV prevention trials in Africa

2008 ◽  
Vol 84 (5) ◽  
pp. 364-370 ◽  
Author(s):  
M L Grijsen ◽  
S M Graham ◽  
M Mwangome ◽  
P Githua ◽  
S Mutimba ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sexually Transmitted Infections ◽  
Sexually Transmitted ◽  
Prevention Trials

scholarly journals Incidence and Correlates of Sexually Transmitted Infections Among Black Men Who Have Sex With Men Participating in the HIV Prevention Trials Network 073 Preexposure Prophylaxis Study

2019 ◽  
Vol 69 (9) ◽  
pp. 1597-1604 ◽  
Author(s):  
Lisa B Hightow-Weidman ◽  
Manya Magnus ◽  
Geetha Beauchamp ◽  
Christopher B Hurt ◽  
Steve Shoptaw ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sexually Transmitted Infections ◽  
Black Men ◽  
Sexual Behaviors ◽  
Nucleic Acid Amplification ◽  
Sexually Transmitted ◽  
Preexposure Prophylaxis ◽  
Centered Care ◽  
Prevention Trials ◽  
Sex With Men

Abstract Background The HIV Prevention Trials Network (HPTN) Study 073 (HPTN 073) assessed the feasibility, acceptability, and safety of preexposure prophylaxis (PrEP) for black men who have sex with men (BMSM). The purpose of this analysis was to characterize the relationship between PrEP uptake and use and incident sexually transmitted infections (STIs) among participants enrolled in HPTN 073. Methods A total of 226 human immunodeficiency virus (HIV)–uninfected BMSM were enrolled in 3 US cities; all participants received client-centered care coordination (C4) and were offered daily oral PrEP. Participants were followed for 12 months with STI testing (rectal and urine nucleic acid amplification test for gonorrhea and chlamydia, rapid plasma reagin for syphilis) conducted at baseline, week 26, and week 52. Logistic regression was used to examine associations between STI incidence and PrEP uptake. Generalized estimating equations were used to evaluate associations between age, PrEP acceptance, sexual behaviors, and incident STIs. Results Baseline STI prevalence was 14.2%. Men aged <25 years were more likely to have a baseline STI (25.3% vs 6.7%; odds ratio [OR], 4.39; 95% confidence interval [CI:, 1.91, 10.11). Sixty participants (26.5%) acquired ≥1 STI during follow-up; the incidence rate was 34.2 cases per 100 person-years (95% CI, 27.4, 42.9). In adjusted analyses, baseline STI diagnosis (OR, 4.23; 95% CI, 1.82, 9.87; P < .001) and additional C4 time (OR, 1.03; 95% CI, 1.00, 1.06; P = .027) were associated with having an incident STI. STI incidence was not associated with PrEP acceptance or adherence. Conclusions While we found higher rates of STIs in younger BMSM, overall rates of STI were lower than in prior PrEP trials, with no increase over time. BMSM with STIs at PrEP initiation may require additional interventions that target STI acquisition risk. Clinical Trials Registration NCT01808352.

scholarly journals Incidence and time-varying predictors of HIV and sexually transmitted infections among male sex workers in Mexico City

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Karla Y. Ganley ◽  
Marta Wilson-Barthes ◽  
Andrew R. Zullo ◽  
Sandra G. Sosa-Rubí ◽  
Carlos J. Conde-Glez ◽  
...  
Keyword(s):  
Sexually Transmitted Infections ◽  
Mexico City ◽  
Sex Workers ◽  
Incidence Rates ◽  
Consistent Condom ◽  
Vaginal Intercourse ◽  
Time Varying ◽  
Male Sex Workers ◽  
Sexually Transmitted ◽  
Male Sex

Abstract Background Male sex workers are at high-risk for acquisition of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). We quantified incidence rates of STIs and identified their time-varying predictors among male sex workers in Mexico City. Methods From January 2012 to May 2014, male sex workers recruited from the largest HIV clinic and community sites in Mexico City were tested for chlamydia, gonorrhea, syphilis, hepatitis, and HIV at baseline, 6-months, and 12-months. Incidence rates with 95% bootstrapped confidence limits were calculated. We examined potential time-varying predictors using generalized estimating equations for a population averaged model. Results Among 227 male sex workers, median age was 24 and baseline HIV prevalence was 32%. Incidence rates (per 100 person-years) were as follows: HIV [5.23; 95% confidence interval (CI): 2.15–10.31], chlamydia (5.15; 95% CI: 2.58–9.34), gonorrhea (3.93; 95% CI: 1.88–7.83), syphilis (13.04; 95% CI: 8.24–19.94), hepatitis B (2.11; 95% CI: 0.53–4.89), hepatitis C (0.95; 95% CI: 0.00–3.16), any STI except HIV (30.99; 95% CI: 21.73–40.26), and any STI including HIV (50.08; 95% CI: 37.60–62.55). In the multivariable-adjusted model, incident STI (excluding HIV) were lower among those who reported consistently using condoms during anal and vaginal intercourse (odds ratio = 0.03, 95% CI: 0.00–0.68) compared to those who reported inconsistently using condoms during anal and vaginal intercourse. Conclusions Incidence of STIs is high among male sex workers in Mexico City. Consistent condom use is an important protective factor for STIs, and should be an important component of interventions to prevent incident infections.

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