The HIV and sexually transmitted infection syndemic following mass scale-up of combination HIV interventions in two communities in southern Uganda: a population-based cross-sectional study

Grabowski, M Kate; Mpagazi, Josephine; Kiboneka, Stephen; Ssekubugu, Robert; Kereba, John Baptiste; Nakayijja, Annet; Tukundane, Julius; Jackson, Jade C.; Peer, Austin D.; Kennedy, Caitlin E.; Kigozi, Godfrey; Manabe, Yukari C.; Chang, Larry W.; Kalibala, Sarah; Gray, Ronald H.; Wawer, Maria J.; Reynolds, Steven J.; Tobian, Aaron A.R.; Serwadda, David; Gaydos, Charlotte A.; Kagaayi, Joseph; Quinn, Thomas C.; Nabukalu, Dorean; Ndyanabo, Anthony; Ssekasanvu, Joseph; Nakawooya, Hadijja; Nakukumba, Jessica; Kigozi, Grace; Nantume, Betty; Resty, Nampijja; Kambasu, Jedidah; Nalugemwa, Margaret; Nakabuye, Regina; Ssebanobe, Lawrence; Nankinga, Justine; Kayiira, Adrian; Nanfuka, Gorreth; Ahimbisibwe, Ruth; Tomusange, Stephen; Galiwango, Ronald M.; Nakalanzi, Margaret; Nalukwago, Aisha; Otobi, Joseph Ouma; Ankunda, Denis; Ssembatya, Joseph; Ssemanda, John B.; Kairania, Robert; Kato, Emmanuel; Kisakye, Alice; Batte, James; Ludigo, James; Nampijja, Abisagi; Watya, Steven; Nehemia, Kighoma; Anyokot, Sr Margaret; Mwinike, Joshua; Kibumba, George; Ssebowa, Paschal; Mondo, George; Wasswa, Francis; Nantongo, Agnes; Kakembo, Rebecca; Galiwango, Josephine; Ssemango, Geoffrey; Redd, Andrew D.; Laeyendecker, Oliver; Santelli, John; Wagman, Jennifer A.; Fernandez, Rey; Sewankambo, Nelson

doi:10.1016/s2214-109x(22)00424-7

Cited by 13 publications

(19 citation statements)

References 21 publications

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“…This study was nested in the STI prevalence study (STIPS), a population-based survey conducted in the Rakai region of south-central Uganda that aimed to estimate population STI burden [ 16 ]. STIPS was conducted as a part of the Rakai Community Cohort Study (RCCS), one of the oldest population-based studies of HIV in Africa.…”

Section: Methodsmentioning

confidence: 99%

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Nearly half of adults with symptoms of sexually transmitted infections (STIs) did not seek clinical care: A population-based study of treatment-seeking behavior among adults in Rakai, Uganda

Kennedy

Nalugoda

Mpagazi

et al. 2023

PLOS Glob Public Health

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Understanding treatment-seeking behavior is critical to the treatment and control of sexually transmitted infections (STIs), yet current data on STI treatment seeking in low-resource settings is rare. This population-based study aimed to describe STI treatment-seeking behavior and identify factors associated with seeking treatment at a clinic among adults with STI-related symptoms in rural Uganda. The STI prevalence study (STIPS) conducted a survey and STI testing among all consenting adults aged 18–49 in two communities in rural south-central Uganda. Of 1,825 participants, 962 individuals self-reported STI symptoms in the past six months; we present descriptive data on treatment seeking and STI prevalence among these individuals. We used multivariable Poisson regressions with robust variance to determine the sociodemographic and symptom-related factors independently associated with seeking STI treatment at a clinic and assessed the association with previous clinic treatment seeking and current STI diagnosis. Forty-three percent of adults who reported STI-related symptoms in the past six months said they did not seek any treatment. Among those who did, 58% sought treatment at a private clinic, 28% at a government clinic, 9% at a pharmacy/drug store, 3% at a traditional healer, 2% at a market/shop, and 5% at another location. Among both males and females, having multiple STI related symptoms was positively associated with clinic treatment seeking (males = PRR: 1.73, 95%CI: 1.36–2.21; females = PR: 1.41, 95%CI: 1.12–1.78). Approximately one-third of males and females who reported previously seeking clinic treatment for their symptoms were diagnosed with a curable STI at the time of the survey. In this setting, nearly half of adults with STI-related symptoms are not seeking clinical care and many who report having sought treatment for recent STI symptoms have curable STIs. Future studies should explore barriers to care-seeking and strategies to improve STI services.

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Section: Methodsmentioning

confidence: 99%

“…STIPS was a population-based survey that recruited all individuals aged 18–49 years from two RCCS communities—one inland and one fishing—from May to October 2019 [ 16 ]. These communities were selected because of their representativeness, geographical diversity, population size, and enrollment timelines within the RCCS survey.…”

Section: Methodsmentioning

confidence: 99%

Nearly half of adults with symptoms of sexually transmitted infections (STIs) did not seek clinical care: A population-based study of treatment-seeking behavior among adults in Rakai, Uganda

Kennedy

Nalugoda

Mpagazi

et al. 2023

PLOS Glob Public Health

Self Cite

View full text Add to dashboard Cite

show abstract

“…This study was conducted as part of the STI prevalence study (STIPS), a population-based survey conducted in the Rakai region of South-central Uganda that aimed to estimate the population STI burden [15]. STIPS was conducted as a part of the Rakai Community Cohort Study (RCCS), one of the oldest population-based studies of HIV in Africa.…”

Section: Methodsmentioning

confidence: 99%

“…STIPS was a population-based survey that recruited all individuals aged 18-49 years from two RCCS communities – one inland and one fishing – from May to October 2019 [15]. Three adjacent villages consisting of semi-urban and rural agrarian populations comprised the inland community and one fish landing site along Lake Victoria comprised the fishing community.…”

Section: Methodsmentioning

confidence: 99%

Nearly half of adults with symptoms of sexually transmitted infections (STIs) did not seek clinical care: A population-based study of treatment-seeking behavior among adults in Rakai, Uganda

Kennedy

Nalugoda

Mpagazi

et al. 2023

Preprint

Self Cite

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Understanding treatment-seeking behavior is critical to the treatment and control of sexually transmitted infections (STIs), yet current data on STI treatment-seeking in low-resource settings is scarce. This study aims to describe STI treatment-seeking behavior and identify factors associated with seeking treatment at a clinic among adults with STI-related symptoms in rural Uganda. The STI prevalence study (STIPS) conducted a population-based survey and STI testing among all consenting adults aged 18–49 in two communities in rural south-central Uganda. Of 1,825 participants, 962 individuals self-reported STI symptoms in the past six months; we present descriptive data on treatment-seeking and STI prevalence among these individuals. We used multivariable Poisson regressions with robust variance to determine the sociodemographic and symptom-related factors independently associated with seeking STI treatment at a clinic and assessed the association with previous clinic treatment-seeking and current STI diagnosis. Forty-three percent of adults who reported STI-related symptoms in the past six months said they did not seek any treatment. Among those who did, 58% sought treatment at a private clinic, 28% at a government clinic, 9% at a pharmacy/drug store, 3% at a traditional healer, 2% at a market/shop, and 5% at another location. Among both men and women, having multiple STI related symptoms was positively associated with clinic treatment seeking (men=PRR: 1.73, 95%CI: 1.36-2.21; women=PR: 1.41, 95%CI: 1.12-1.78). Approximately one-third of men and women who reported previously seeking clinic treatment for their symptoms were diagnosed with a curable STI at the time of the survey. In this setting, nearly half of adults with STI-related symptoms are not seeking clinical care and many who report having sought treatment recent STI symptoms have curable STIs. Future studies should explore barriers to care-seeking and strategies to improve STI services.

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“…Nested within the RCCS, the STI Prevalence Study (STIPS) aimed to estimate STI prevalence among 1,825 sexually active HIV+ and HIV-men and women aged 18–49 years in two communities (one inland and one fishing), from May to October 2019. 26 STIPS participants were tested for Trichomonas vaginalis (TV) (in the field), syphilis (screening in the field; samples tested in the lab), N. gonorrhoeae (NG), C. trachomatis (CT), and herpes simplex virus type 2 (HSV-2) (samples tested in the lab). To this end, three provider-collected penile-meatal swabs were obtained for all male STIPS participants who consented to STI testing.…”

Section: Methodsmentioning

confidence: 99%

The Acceptability of Self-Collected Samples for STI Testing: A Qualitative Study Among Adults in Rakai, Uganda

Grabowski

Nabakka

Ddaaki

et al. 2023

Preprint

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Introduction: Self-collected samples (SCS) for sexually transmitted infection (STI) testing have been shown to be feasible and acceptable in high-resource settings. However, few studies have assessed the acceptability of SCS for STI testing in a general population in low-resource settings. This study explored the acceptability of SCS among adults in south-central Uganda. Methods: Nested within the Rakai Community Cohort Study, we conducted semi-structured interviews with 36 symptomatic and asymptomatic adults who self-collected samples for STI testing. We analyzed the data using an adapted version of the Framework Method. Results: Overall, participants did not find SCS physically uncomfortable. Reported acceptability did not meaningfully differ by gender or symptom status. Perceived advantages to SCS included increased privacy and confidentiality, gentleness, and efficiency. Disadvantages included the lack of provider involvement, fear of self-harm and the perception that SCS was unhygienic. Most participants preferred provider-collected samples to SCS. Nevertheless, almost all said they would recommend SCS and would do it again in the future. Conclusion: Despite a preference for provider-collection, SCS are acceptable among adults in this setting and support expanded access to STI diagnostic services.

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The HIV and sexually transmitted infection syndemic following mass scale-up of combination HIV interventions in two communities in southern Uganda: a population-based cross-sectional study

Cited by 13 publications

References 21 publications

Nearly half of adults with symptoms of sexually transmitted infections (STIs) did not seek clinical care: A population-based study of treatment-seeking behavior among adults in Rakai, Uganda

Nearly half of adults with symptoms of sexually transmitted infections (STIs) did not seek clinical care: A population-based study of treatment-seeking behavior among adults in Rakai, Uganda

Nearly half of adults with symptoms of sexually transmitted infections (STIs) did not seek clinical care: A population-based study of treatment-seeking behavior among adults in Rakai, Uganda

The Acceptability of Self-Collected Samples for STI Testing: A Qualitative Study Among Adults in Rakai, Uganda

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