The HIV and STI syndemic following mass scale-up of combination HIV interventions in Uganda: a population-based cross-sectional study
Year: 2022
Type: preprint
Study design: Observational Study
Abstract: ABSTRACT Background Combination HIV interventions (CHIs) have led to significant declines in HIV incidence in sub-Saharan Africa; however, population-level data on non-HIV sexually transmitted infection (STI) burden in the context of CHIs are rare. We aimed to assess STI burden in Uganda following mass scale-up of CHIs, including universal HIV treatment. Methods The Sexually Transmitted Infection Prevalence Study (STIPS) was a cross-sectional study nested within the Rakai Community Cohort Study (RCCS), a population-based cohort among inland agrarian and Lake Victoria fishing populations in southern Uganda. STIPS enrolled consenting participants, 18-49 years, between May and October 2019 and measured prevalence of Chlamydia trachomatis (chlamydia), Neisseria gonorrhoeae (gonorrhea), Trichomonas vaginalis (trichomonas), syphilis, and herpes simplex virus type 2 (HSV-2). Findings STIPS enrolled 1,825 participants, including 965 women (53%), of whom 9% (n=107) were pregnant. Overall, there was 9.8% prevalence of chlamydia (95%CI:8.5-11%), 6.7% gonorrhea (95%CI:5.7-8.0%), and 11% trichomonas (95%CI:9.5-12%). In the fishing population, syphilis reactivity was 24% (95%CI:22-27%), with 9.4% (95%CI:7.7-11%) having high titer (RPR ≥ 1:8) infection, including 17% (95%CI:12-24%) of HIV-positive men. Prevalence of ≥ 1 curable STI (chlamydia, gonorrhea, trichomonas, or high titer syphilis) was 44% higher among HIV-positive persons (adjusted prevalence risk ratio [adjPRR]=1.44,95%CI:1.22-1.71), with no differences by HIV treatment status. HIV-positive pregnant women were more likely than HIV-negative pregnant women to have a curable STI (adjPRR=1.87, 95%CI: 1.08-3.23). Interpretation STI burden remains extremely high in Uganda, particularly among HIV-positive persons. There is an urgent need to integrate STI diagnostic testing and treatment with HIV services in African settings. Funding National Institutes of Health
Source: medRxiv
Authors: M. Kate Grabowski, Josephine Mpagazi, Stephen Kiboneka, Robert Ssekubugu, John Baptiste Kereba, Annet Nakayijja, Julius Tukundane, Jade Jackson, Austin D. Peer, Caitlin Kennedy, Godfrey Kigozi, Ronald M. Galiwango, Yuka Manabe, Larry W. Chang, Sarah Kalibala, Ronald H Gray, Maria J Wawer, Steven J Reynolds, Aaron AR Tobian, David Serwadda, Charlotte A. Gaydos, Joseph Kagaayi, Thomas C Quinn
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Johns Hopkins University, Centers for Disease Control and Prevention, Center for AIDS Research, University of Washington, Center for AIDS Research, Johns Hopkins University, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Human Development, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NHLBI Division of Intramural Research
Awards: G2483435703, RCT to reduce HIV acquisition and viral load among migrants, Rakai, Uganda, PROVISION OF COMPREHENSIVE HIV/AIDS SERVICES AND DEVELOPING NATIONAL CAPACITY TO, CHWs, mHealth, and Combination HIV Prevention in a Hotspot: A Randomized Trial, G653582874, G6808709389, G7178514535, G731302033, G890594366, The Johns Hopkins Center for AIDS Research (JHU CFAR)
OpenAlex ID: W4223963765