The Epidemiology of Human Immunodeficiency Virus (HIV) and Syphilis in Ghana: A Five-Year Single Urban Site Parallel Population-Based Analysis vis-à-vis the Sentinel Survey

Abstract

The study was aimed at comparing the estimation of the burden and trends (2012–2016) of Human Immunodeficiency Virus (HIV) and Syphilis infections by the national Sentinel Survey vis-à-vis the use of population-based studies at a single urban site (Municipal Hospital) in Ho, the Volta Region of Ghana. Using blood donors as a proxy of the asymptomatic adult population, a retrospective analysis of secondary data on HIV and Syphilis testing was conducted using Ho Municipal Hospital's archives comprising 4,180 prospective blood donors. Published reports from the National Sentinel Survey for the Ho Sentinel Site comprising 2,452 pregnant women from 2012 to 2016 were used. The cumulative prevalence of HIV and Syphilis infections in the population-based survey was 4.78% and 2.58% while the epidemiology was estimated at 2.75% and 0.24% by the Sentinel Survey for the five-year under review. The new HIV and Syphilis infections were 3.78% and 2.46% in the population-based survey compared to 2.64% and 0.23% in the Sentinel Survey. Gender cumulative prevalence and the yearly trend was found to be higher in the general population compared to the pregnant women. The use of pregnant women to estimate the HIV and Syphilis epidemiology might not be representative of the general population.

A comparative study of the epidemiology of Treponemal Infection in the Volta Region of Ghana: A Five-Year Multisite Parallel Population-Based Analysis vis-à-vis the Sentinel Survey

“…In our previous study, we have observed male preponderance to Treponemal infection [16], and also in the works of Anwar, et al [45]. On the contrary, Coffin, et al [46] and Gao, et al [47], opined that females were more susceptible to Treponemal infection than their male counterparts.…”

“…To the best of our knowledge, this is the first comparative study aimed at describing the In general, the cumulative and yearly prevalence of Treponemal infection were significantly higher in the population-based group as compared to that recorded in the Sentinel Survey (p< 0.05), except for year 2017 where the difference was comparable between the two groups (p=0.1416) (Table 1). Thus, our earlier finding of a difference in the rate of Treponemal infections between the two sample groups was not limited to the Ho sentinel site [16], but represents a regional picture. Earlier reports in other African countries also corroborated the results of this study.…”

“…Studies in Tanzania [31][32][33], Uganda [34] and Zambia [35] reported that sexually transmitted pathogens were 10-30% lower in pregnant women in the Sentinel Survey compared to individuals in the general population. The finding of a lower rate of Treponemal infection in the Sentinel Survey compared to the population based group [16] raises important questions about the representativeness of the use of pregnant women for population estimates in the study jurisdiction. According to Boisson, et al [36] and Zaba and Gregson [37], biases exist for using pregnant women as proxy for estimating the prevalence of sexually transmitted pathogens.…”

“…This then called for the recommendation that periodic validations of ANC surveillance data are carried out through the conduct of population-based studies in countries with generalized epidemiology [15]. In pursuant to this recommendation, we previously described the epidemiology of Treponemal infection by comparing estimates from the sentinel survey with those observed among asymptomatic adult population using prospective blood donors as a proxy at the Ho Sentinel site in the Volta Region [16]. Findings from that study suggested that the use of only pregnant women might underestimate the population burden of the disease, laying credence to a possible unrepresentativeness of the use of Sentinel Surveys.…”

Factors associated with syphilis infection: a cross-sectional survey among outpatients in Asikuma Odoben Brakwa District, Ghana

“…Communities in that sub-district lack access to commodities like condoms for prevention of STIs as well as effective health education programmes. In a similar cross-sectional study among antenatal women in Northern Tanzania, syphilis prevalence was found to be higher in rural clinics than those in the urban area [29]. Significant association has been reported between history of coerced sex and syphilis infection in earlier studies.…”