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  • Cross-sectional assessment of determinants of STIs among men who have sex with men and transgender women in Kigali, Rwanda

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Epidemiology
Original research
Cross-sectional assessment of determinants of STIs among men who have sex with men and transgender women in Kigali, Rwanda
  1. Jean Olivier Twahirwa Rwema1,
  2. Sara Herbst2,
  3. Matthew M Hamill3,
  4. Benjamin Liestman1,
  5. Julien Nyombayire4,
  6. Carrie E Lyons1,
  7. Placidie Mugwaneza5,
  8. Jean Damascène Makuza5,
  9. Patrick Sean Sullivan2,
  10. Susan Allen6,
  11. Etienne Karita4,
  12. Stefan Baral1
  1. 1 Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2 Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia, USA
  3. 3 Infectious Diseases, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
  4. 4 Projet San Francisco, Kigali, Rwanda
  5. 5 IHDPC, Rwanda Biomedical Center, Kigali, Rwanda
  6. 6 Rwanda Zambia HIV Research Group, Emory University, Atlanta, Georgia, USA
  1. Correspondence to Dr Jean Olivier Twahirwa Rwema, Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA; jtwahir1{at}jhmi.edu

Abstract

Background STIs among men who have sex with men (MSM) and transgender women (TGW) continue to increase. In Rwanda, STI management relies on syndromic management with limited empirical data characterising the burden of specific STIs among MSM/TGW. This study evaluated the prevalence of syphilis, Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) and associated factors among MSM/TGW in Kigali.

Methods From March to August 2018, 737 MSM/TGW >18 years were enrolled using respondent-driven sampling (RDS). Structured interviews and HIV/STI screening were conducted. Syphilis was screened with rapid plasma reagin confirmed by Treponema pallidum hemagglutination assay. CT/NG were tested by Cepheid GeneXpert. RDS-adjusted multivariable Poisson regression models with robust variance estimation were used to evaluate factors associated with any STI, and determinants of urethral and rectal STIs separately.

Results Prevalence of any STI was 20% (RDS adjusted: 16.7% (95% CI: 13.2% to 20.2%)). Syphilis was 5.7% (RDS adjusted: 6.8% (95% CI: 4.3% to 9.4%)). CT was 9.1% (RDS adjusted: 6.1% (95% CI: 3.9% to 8.4%)) and NG was 8.8% (RDS adjusted: 7.1% (95% CI: 4.9% to 9.2%)). STIs were more common among older MSM and those with HIV (p<0.05). Of CT infections, 67% were urethral, 27% rectal and 6% were dual site. For NG infections, 52% were rectal, 29% urethral and 19% were dual site. Overall, 25.8% (23 of 89) of those with confirmed STI and returned for their results were symptomatic at time of testing.

STI symptoms in the previous year (adjusted prevalence ratio (aPR): 1.94 (95% CI: 1.26 to 2.98)) were positively associated with any STI. Being circumcised was negatively associated with any STI (aPR: 0.47 (95% CI: 0.31 to 0.73)). HIV was positively associated with rectal STIs (aPR: 3.50 (95% CI: 1.09 to 11.21)) but negatively associated with urethral STIs.

Conclusion MSM/TGW, especially those living with HIV, are at high risk of STIs in Rwanda with the vast majority being asymptomatic. These data suggest the potential utility of active STI surveillance strategies using highly sensitive laboratory methods among those at high risk given the anatomical distribution and limited symptomatology of STIs observed among Rwandan MSM/TGW.

  • gonorrhoea
  • gay men
  • transgender
  • chlamydia trachomatis
  • epidemiology (general)

Data availability statement

Data are available upon reasonable request. The de-identified data are owned by the partner institutions. Requests for data utilisation should be sent to SB: sbaral@jhu.edu.

https://doi.org/10.1136/sextrans-2020-054753

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    Data availability statement

    Data are available upon reasonable request. The de-identified data are owned by the partner institutions. Requests for data utilisation should be sent to SB: sbaral@jhu.edu.

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    Footnotes

    • Handling editor Katy M E Turner

    • Twitter @TwahirwaOlivier, @pssinatl

    • Contributors SB, SA, EK, PSS and PM conceived and designed the study. JOTR, BL, JN, SH and CEL oversaw implementation and data collection. JOTR analysed the data. JOTR wrote the first draft of the paper. All authors reviewed, edited and approved the manuscript.

    • Funding This study was supported by the Center for Disease Control and Prevention (CDC) through PEPFAR COAG NU2GGH001443 and supervised by CDC–Rwanda AIDS office. SB’s effort was supported in part by a grant from the National Institutes of Mental Health (R01MH110358). PSS’s effort was supported in part by the Emory University Center for AIDS Research (P30AI050409).

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.