Risk Factors for Incidence of Sexually Transmitted Infections Among Women in South Africa, Tanzania, and Zambia: Results From HPTN 055 Study

Kapiga, Saidi; Kelly, Christopher S; Weiss, Stephen M.; Daley, Tara; Peterson, Leigh; Leburg, Corey; Ramjee, Gita

doi:10.1097/olq.0b013e318191ba01

Cited by 35 publications

(65 citation statements)

References 26 publications

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“…STI prevalence in participants at screening (0.7% NG, 3.5% CT, 7.3% TV) was similar to that anticipated, based on preparatory study HPTN 055 in Hlabisa and Durban, South Africa, and Lusaka, Zambia,25 and during HPTN 035, these STIs occurred at rates of 1.6, 3.9 and 15.3 per 100-person years (NG, CT and TV, respectively). Reported uptake of gel products was adequate (81% in all groups by self-report), and no risk compensation was identified as a result of gel usage as compared with the no gel group.…”

Section: Discussionsupporting

confidence: 81%

“…Throughout, the overall reported use of condoms at last vaginal sex was 74% (range 51–77%), but it is very likely that self-reported condom use was an overestimate of actual use, and probable that the residual unprotected sexual acts remained sufficient to account for the STI transmissions. Low uptake of condoms in some of these communities and reasons for this have been previously identified highlighting the limitation of using condoms for STI and HIV prevention in women in many African communities25 since women may not be able to negotiate their use with male partners 27. Reported condom use was higher in the no gel group compared with the gel arms (81% vs 72%), but this modest difference in self-reported condom use did not correlate with a decreased incidence of STIs in the no gel group.…”

Section: Discussionmentioning

confidence: 96%

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HPTN 035 phase II/IIb randomised safety and effectiveness study of the vaginal microbicides BufferGel and 0.5% PRO 2000 for the prevention of sexually transmitted infections in women

et al. 2014

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Objectives To estimate the effectiveness of candidate microbicides BufferGel and 0.5% PRO 2000 Gel (P) (PRO 2000) for prevention of non-ulcerative sexually transmitted infections (STIs). Methods Between 2005 and 2007, 3099 women were enrolled in HIV Prevention Trials Network (HPTN) protocol 035, a phase II/IIb evaluation of the safety and effectiveness of BufferGel and PRO 2000 for prevention of sexually transmitted infections, including Neisseria gonorrhoeae (GC), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV). Incidences of STIs were determined by study arm, and hazard ratios (HRs) of BufferGel and PRO 2000 versus placebo gel or no gel control groups were computed using discrete time Andersen-Gill proportional hazards model. Results The overall incidence rates were 1.6/100 person-years at risk (PYAR) for GC, 3.9/100 PYAR for CT, and 15.3/100 PYAR for TV. For BufferGel versus placebo gel, HRs were 0.99 (95% CI 0.49–2.00), 1.00 (95% CI 0.64–1.57), and 0.95 (95% CI 0.71–1.25) for prevention of GC, CT, and TV respectively. For PRO 2000, HRs were 1.66 (95% CI 0.90–3.06), 1.16 (95% CI 0.76–1.79), and 1.18 (95% CI 0.90–1.53) for prevention of GC, CT, and TV respectively. Conclusions The incidence of STIs was high during HPTN 035 despite provision of free condoms and comprehensive risk-reduction counselling, highlighting the need for effective STI prevention programmes in this population. Unfortunately, candidate microbicides BufferGel and PRO2000 had no protective effect against gonorrhoea, Chlamydia, or trichomoniasis.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 96%

HPTN 035 phase II/IIb randomised safety and effectiveness study of the vaginal microbicides BufferGel and 0.5% PRO 2000 for the prevention of sexually transmitted infections in women

et al. 2014

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“…3,13 Furthermore, the prevalence of HIV antibodies was stable in accordance with previous reports. 20,21 The observation of some STIs being common and more prevalent among HIV-infected pregnant women compared with their uninfected counterparts was also found in other studies; STIs producing ulcerative lesions such as syphilis are associated with a higher rate of HIV transmission. 22 Data from the surveillance of HIV and syphilis 2003/2004 showed the syphilis prevalence in Tanga to be 3.3%.…”

Section: Discussionmentioning

confidence: 66%

Prevalence of sexually transmitted infections among women attending antenatal clinics in Tanga, north eastern Tanzania

et al. 2012

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This study aimed to determine the prevalence of sexually transmitted infections (STIs) among HIV-infected and uninfected pregnant women in Tanga, Tanzania. Retrospective data on syphilis and HIV status during 2008-2010 were collected from antenatal clinic (ANC) records. Prospective data were collected from HIV-infected (n = 105) and HIV-uninfected pregnant women (n = 100) attending ANCs between April 2009 and August 2010. Syphilis prevalence showed a declining trend (3.1%, 1.4% and 1.3%), while HIV prevalence was stable (6.1%, 6.4% and 5.4%) during 2008-2010. HIV-infected women had significantly higher prevalence of trichomoniasis (18.8% versus 5.0%; P < 0.003) and candidiasis (16.5% versus 2.0%; P < 0.001) while the higher rate of gonorrhoea (3.5% versus 0%; P = 0.095) was not statistically significant when compared with HIV-uninfected women. There were no statistically significant differences in prevalence of chlamydial infection (0% versus 3.0%; P = 0.156) or syphilis (2.4% versus 3.0%; P = 1) between HIV-infected and uninfected women. Other STIs were common in both HIV-infected and uninfected pregnant women.

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“…STI and HIV testing was described previously for each study [12,15,16]. Briefly, in the MIRA trial, [16] CT, GC and TV were detected by PCR (Roche Pharmaceuticals, Branchburg, NJ, USA) and syphilis by rapid plasma reagin (RPR) and Treponema pallidum haemagglutinin (TPHA) (Randox Laboratories, Crumlin, UK).…”

Section: Methodsmentioning

confidence: 99%

“…Briefly, in the MIRA trial, [16] CT, GC and TV were detected by PCR (Roche Pharmaceuticals, Branchburg, NJ, USA) and syphilis by rapid plasma reagin (RPR) and Treponema pallidum haemagglutinin (TPHA) (Randox Laboratories, Crumlin, UK). In HPTN 055 [15], CT and GC were detected using the BDProbe Tec ET assay (Becton Dickinson, MD), TV by wet mount microscopy and syphilis by RPR and confirmatory TPHA. In MDP Feasibility [16], CT and GC were detected using PCR (COBAS Amplicor, Roche Molecular Diagnostics, Pleasanton, CA, USA), TV by wet mount microscopy and syphilis by RPR and confirmatory TPHA (Omega Diagnostics, Alva, UK).…”

Section: Methodsmentioning

confidence: 99%

High prevalence and incidence of sexually transmitted infections among women living in Kwazulu-Natal, South Africa

et al. 2014

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Background and objectivesSexually transmitted infections (STIs) contribute largely to the burden of health in South Africa and are recognized as major contributors to the human immunodeficiency virus (HIV) epidemic. Young women are particularly vulnerable to STIs. The purpose of this secondary analysis was to examine the risk factors associated with prevalent and incident STIs among women who had participated in three clinical trials.MethodsA total of 5,748 women were screened and 2293 sexually active, HIV negative, non-pregnant women were enrolled in three clinical trials in Kwazulu-Natal, South Africa. The prevalence of individual STIs Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), syphilis, and Trichomonas vaginalis (TV) was assessed at screening; and incident infections were evaluated over a 24 month period.ResultsOverall, the combined study population of all three trials had a median age of 28 years (inter-quartile range (IQR):22–37), and a median duration of follow-up of 12 months. Prevalence of STIs (CT, NG, TV, or syphilis) was 13% at screening. The STI incidence was estimated to be 20/100 women years. Younger women (<25 years, p < 0.001), women who were unmarried (p < 0.001) and non-cohabiting women (p < 0.001) were shown to be at highest risk for incident STIs.ConclusionsThese results confirm the extremely high prevalence and incidence of STIs among women living in rural and urban communities of KwaZulu-Natal, South Africa, where the HIV epidemic is also particularly severe. These findings strongly suggest an urgent need to allocate resources for STI and HIV prevention that mainly target younger women.Trial registrationClinical Trials.gov, NCT00121459.

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Risk Factors for Incidence of Sexually Transmitted Infections Among Women in South Africa, Tanzania, and Zambia: Results From HPTN 055 Study

Abstract: The incidence of STIs, including HIV, was high among women in this study. These findings highlight the urgent need for effective HIV/STI prevention programs in this population.

Cited by 35 publications

References 26 publications

HPTN 035 phase II/IIb randomised safety and effectiveness study of the vaginal microbicides BufferGel and 0.5% PRO 2000 for the prevention of sexually transmitted infections in women

HPTN 035 phase II/IIb randomised safety and effectiveness study of the vaginal microbicides BufferGel and 0.5% PRO 2000 for the prevention of sexually transmitted infections in women

Prevalence of sexually transmitted infections among women attending antenatal clinics in Tanga, north eastern Tanzania

High prevalence and incidence of sexually transmitted infections among women living in Kwazulu-Natal, South Africa

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