P5.041 TB Treatment For HIV Positive Pregnant Women: Challenges to Screening and Diagnosis

Abstract

Background Sub-Saharan Africa has the highest rates of curable sexually transmitted infections (STIs) globally with the greatest morbidity due to Neisseria gonorrhoea and Chlamydia trachomatis falling on women. In response to a demand for comprehensive reproductive health screening, we proposed that providing additional N. gonorrhoea and C. trachomatis testing within a cervical cancer screening programme involving self swabbing for HPV, would be acceptable and effective. Methods As part of a cervical cancer screening project in Kisenyi, a densely populated urban community in Kampala, Uganda with low socio-economic-indicators, women aged 30 to 69 were offered N. gonorrhoea and C. trachomatis testing using self-collected swabs. Women were recruited in each sub-division by local health workers, after informed consent, a brief demographic and attitudes survey was completed and the method of swab collection was explained. Specimens were transported for PCR analysis within Kampala. Participants were contacted by mobile phone and asked to attend the local health clinic to receive appropriate treatment if found to be positive. Results Out of 206 women approached, 203 provided a self collected swab for analysis. Twenty-six women (13%) were found to have C. trachomatis, 2 (< 1%) were positive for N. gonorrhoea and one participant was co-infected. Of the women infected, 76% were successfully contacted and of these 62% attended follow-up to receive appropriate treatment. Women reporting no condom use in the last month accounted for 93% of those with C. trachomatis while use of the oral contraceptive pill was not associated with higher rates of either infection. The self-reported HIV positivity rate was 9.5%. Discussion The acceptance and uptake of testing for common STIs in this urban sub-Saharan environment was very positive. Due to the high burden of disease inferred by these easily treated infections, further integration of appropriate screening should be incorporated into existing reproductive health programmes. Background According to Kenya's PMTCT guidelines, all HIV positive women who present for antenatal care should be tested for TB.Methods HIV-positive, pregnant women were recruited from two maternity hospitals in Nairobi, Kenya. The results presented here are based on surveys completed at baseline as well as 48 hour follow up. This data was collected from 505 women as part of a study on the use of mobile technology in PMTCT programmes. Questionnaires included questions on socio-economic characteristics, history of current and previous pregnancies, knowledge of PMTCT, TB screening and treatment and the use of Nevirapine. Chi-square tests and multivariable logistic regression were used to assess statistically significant associations between variables of interest and TB screening.Results Overall screening for TB in our sample was 10.3% with no significant difference between the two hospitals (11.4% versus