Sexually Transmitted Infections Among HIV-Infected Adults in HIV Care Programs in Kenya

Abstract

Background Identifying sexually transmitted infections (STI) in HIV-infected individuals has potential to benefit individual and public health. There are few guidelines regarding routine STI screening in sub-Saharan African HIV programs. We determined sexual risk behavior and prevalence and correlates of STI in a national survey of large HIV treatment programs in Kenya. Methods A mobile screening team visited 39 (95%) of the 42 largest HIV care programs in Kenya and enrolled participants using population-proportionate systematic sampling. Participants provided behavioral and clinical data. Genital and blood specimens were tested for trichomoniasis, gonorrhea, chlamydia, syphilis, and CD4 T-lymphocyte counts. Results Among 1661 adults, 41% reported no sexual partners in the past 3 months. Among those who reported sex in the past 3 months, 63% of women reported condom use during this encounter compared with 77% of men (P < 0.001). Trichomoniasis was the most common STI in women (10.9%) and men (2.8%); prevalences of gonorrhea, chlamydia, and syphilis were low (<1%–2%). Among women, younger age (adjusted odds ratio [OR], 0.96 per year; 95% confidence interval [CI], 0.94–0.98) and primary school education or lower level (adjusted OR, 2.16; 95% CI, 1.37–3.40) were independently associated with trichomoniasis, whereas CD4 count, cotrimoxazole use, and reported condom use were not. Reported condom use at last sex was associated with reporting that the clinic provided condoms among both women (OR, 1.7; 95% CI, 1.17–2.35) and men (OR, 2.4; 95% CI, 1.18–4.82). Conclusions Women attending Kenyan HIV care programs had a 10.9% prevalence of trichomoniasis, suggesting that screening for this infection may be useful. Condom provision at clinics may enhance secondary HIV prevention efforts.

Prevalence and Correlates of Genital Infections Among Newly Diagnosed Human Immunodeficiency Virus–Infected Adults Entering Human Immunodeficiency Virus Care in Windhoek, Namibia

“…Similar to other studies of HIV-infected women, 16,18,19 trichomoniasis had the highest prevalence in our study. Trichomoniasis, the second most common STI in the world, 20 is also known to be more prevalent in HIV-positive women 21 and is associated with significant morbidity, including pelvic inflammatory disease, cervical dysplasia, and adverse reproductive health outcomes.…”

“…Based on the rates of trichomoniasis found in this study, implementation of primary and secondary prevention that include at least annual laboratory-based screening for trichomoniasis and other vaginal infections and prompt treatment 19,29 may be warranted to reduce morbidity, improve quality of life, and decrease HIV genital shedding associated with the risk of HIV transmission. These strategies should be coupled with aggressive partner notification and management.…”

Genital infections and syndromic diagnosis among HIV-infected women in HIV care programmes in Kenya

“…While annual laboratory-based screening for trichomoniasis among HIV-infected women has been recommended in a few studies (4, 11), aggressive partner notification and management should be equally sought. Growing evidence indicates genital microbiota is shared between sexual partners (12) and trichomoniasis prevalence may rise up to 73% among male partners of women diagnosed with vaginal trichomoniasis (13).…”

“…Sampling and procedures for this study have been previously described by Singa et al (4). Sociodemographic, sexual risk behaviors data and HIV/medical history were collected.…”

Sintomas de ansiedade, depressão, nível de estresse, uso de álcool e outras drogas e repertório de habilidades sociais como fatores relacionados ao comportamento sexual de risco em pessoas infectadas pelo HIV em tratamento na cidade de São Paulo

“…A falta de conhecimento dos riscos de reinfecção e a crença de que não haveria risco de contaminação pelo fato de a carga viral estar baixa e por estar em tratamento antirretroviral são alguns dos fatores relacionados à prática de sexo sem preservativo entre pessoas soroconcordantes (Singa et al, 2013;UNAIDS, 2013).…”