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High Incidence of Curable Sexually Transmitted Infections Among Persons Accessing Oral Preexposure Prophylaxis at an Integrated Sexually Transmitted Infection/Preexposure Prophylaxis Clinic in Lilongwe, Malawi

Year: 2025

Type: article

Abstract: BACKGROUND: Understanding the burden of incident sexually transmitted infections (STIs) among persons in Eastern and Southern Africa after initiating HIV preexposure prophylaxis (PrEP) is critical to allocate scarce STI testing and HIV prevention resources. METHODS: Participants were recruited from an STI clinic in Lilongwe, Malawi (March-December 2022). Eligibility reflected oral PrEP eligibility per contemporary guidelines, limited to persons seeking STI services. We enrolled 3 groups: "index participants" who initiated PrEP, "PrEP-eligible decliners" who declined PrEP, and PrEP-initiating "referred partners" referred by index participants. Surveys and PrEP use assessments were conducted at baseline and at 1, 3, and 6 months; Chlamydia trachomatis, Neisseria gonorrhoeae, and syphilis testing done at baseline and at 3 and 6 months. A subset of participants completed in-depth interviews that were thematically analyzed. RESULTS: We enrolled 238 participants (174 index, 37 PrEP-eligible decliners, 27 referred partners); most were male (58%), and the median age was 27 years (interquartile range, 22-31 years). Forty-seven incident STIs were identified during 89.3 person-years (py) of follow-up (52.6/100 py). Men had a higher incidence versus women (55.8/100 py vs. 48.6/100 py). Index participants had the highest STI incidence (61.3/100 py), compared with PrEP-eligible decliners (26.4/100 py) and referred partners (27.1/100 py). Most incident infections were asymptomatic. Nearly all 27 interviewed participants described an STI as related to perceived HIV risk and need for PrEP. CONCLUSIONS: Incident, asymptomatic STIs in the 6 months after PrEP initiation were common. Testing of STI contextualizes perceived HIV risk and may encourage PrEP persistence. Integrating bacterial STI testing within PrEP care may reduce transmission via expedient treatment and should be considered alongside PrEP program expansion.Clinical Trial Number: NCT05307991 ( https://clinicaltrials.gov/ct2/show/NCT05307991 ).

Source: Sexually Transmitted Diseases

DOI: 10.1097/olq.0000000000002170