STI prevalence, incidence, and partner notification among women in a periconception HIV prevention program in Uganda

Abstract

Background We provided sexually transmitted infection (STI) screening and facilitated partner notification and treatment among women participating in a periconception HIV prevention program in southwestern Uganda to understand follow-up STI incidence. Methods Women at-risk for HIV exposure while planning for pregnancy completed laboratory screening for chlamydia, gonorrhea, trichomoniasis, and syphilis at enrollment and 6 months of follow-up and/or incident pregnancy; facilitated partner notification and treatment were offered for those with positive tests. We performed a logistic regression to determine correlates of follow-up STI. Results Ninety-four participants completed enrollment STI screening with a median age of 29 (IQR 26–34); 23 (24%) had ≥1 STI. Of the 23 participants with enrollment STI(s), all completed treatment and 19 (83%) returned for follow-up; 18 (78%) reported delivering partner notification cards and discussing STIs with partner(s), and 14 (61%) reported all partners received STI treatment. Of the 81 (86%) who successfully completed follow-up STI screening, 17 (21%) had ≥1 STI. The STI incidence rate was 29.0 per 100 person-years. In univariable regression analysis, enrollment STI, younger age, less education, and alcohol consumption were all significantly associated with follow-up STI. Conclusions We demonstrated high enrollment and follow-up STI rates and moderate participant-reported partner treatment among women planning for pregnancy in Uganda despite partner notification and treatment. Novel STI partner notification and treatment interventions are needed to decrease the STI burden, especially among women planning for and with pregnancy.

Sexually Transmitted Infection Prevalence, Partner Notification, and Human Immunodeficiency Virus Risk Perception in a Cohort of Women Completing Sexually Transmitted Infection Screening as Part of a Safer Conception Study

“…This supports recommendations for retesting in 3 to 6 months after infection to detect repeat infections 27 . High rates of PN of STIs (74%–93%) have been observed in Uganda and South Africa among pregnant women, HIV-exposed women planning pregnancy, as well as AGYW, consistent with our findings 20,29,30 . Reported rates of male partner treatment have been lower than notification rates 20,29,30 .…”

“…27 High rates of PN of STIs (74%-93%) have been observed in Uganda and South Africa among pregnant women, HIV-exposed women planning pregnancy, as well as AGYW, consistent with our findings. 20,29,30 Reported rates of male partner treatment have been lower than notification rates. 20,29,30 In our study, most women preferred to notify their partners face to face which is consistent with qualitative research from Botswana and South Africa.…”

“…20,29,30 Reported rates of male partner treatment have been lower than notification rates. 20,29,30 In our study, most women preferred to notify their partners face to face which is consistent with qualitative research from Botswana and South Africa. 31,32 Unlike our study, where most women felt delivering medication to the partner would be helpful, no women preferred to bring STI treatment home to their partners in the Botswana study.…”

Sexually transmitted infection (STI) knowledge and perceptions among people in HIV-sero-different partnerships in rural southwestern Uganda

“…This high STI prevalence is particularly concerning given that Uganda has one of the highest fertility rates in the world, and STIs cause the greatest morbidity and mortality when transmitted vertically to neonates [4][5][6]. In prior work in rural southwestern Uganda, we described an STI prevalence of 24% and a six-month STI incidence of 29.0 per 100 person-years among women without HIV considering pre-exposure prophylaxis (PrEP) with pregnancy plans and an STI prevalence of 22% among men with HIV with partner pregnancy plans [7][8][9].…”

Sexually transmitted infection point-of-care testing in resource-limited settings: a narrative review guided by an implementation framework

“…In 2018, our team incorporated Cepheid GeneXpert molecular near-POC for chlamydia, gonorrhea, and trichomoniasis and SDBioline treponemal immunochromatographic testing confirmed by rapid plasma reagin for syphilis diagnosis at the Mbarara University of Science and Technology Research Laboratory in rural southwestern Uganda [17][18][19] (Fig. 1).…”