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Screening for genital and anorectal sexually transmitted infections in HIV prevention trials in Africa
  1. M L Grijsen1,
  2. S M Graham2,3,
  3. M Mwangome1,
  4. P Githua1,
  5. S Mutimba1,
  6. L Wamuyu1,
  7. H Okuku1,
  8. M A Price4,
  9. R S McClelland2,3,5,
  10. A D Smith6,
  11. E J Sanders1,7
  1. 1
    Centre for Geographic Medicine Research–Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
  2. 2
    Department of Medicine, University of Washington, Seattle, Washington, USA
  3. 3
    Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
  4. 4
    International AIDS Vaccine Initiative, New York, New York, USA
  5. 5
    Department of Epidemiology, University of Washington, Seattle, Washington, USA
  6. 6
    Department of Public Health and Primary Care, University of Oxford, Headington, UK
  7. 7
    Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
  1. Dr E J Sanders, KEMRI, PO Box 230, Kilifi, Kenya; ESanders{at}kilifi.kemri-wellcome.org

Abstract

Objectives: To demonstrate the value of routine, basic sexually transmitted infection (STI) screening at enrolment into an HIV-1 vaccine feasibility cohort study and to highlight the importance of soliciting a history of receptive anal intercourse (RAI) in adults identified as “high risk”.

Methods: Routine STI screening was offered to adults at high risk of HIV-1 upon enrolment into a cohort study in preparation for HIV-1 vaccine trials. Risk behaviours and STI prevalence were summarised and the value of microscopy assessed. Associations between prevalent HIV-1 infection and RAI or prevalent STI were evaluated with multiple logistic regression.

Results: Participants had a high burden of untreated STI. Symptom-directed management would have missed 67% of urethritis cases in men and 59% of cervicitis cases in women. RAI was reported by 36% of male and 18% of female participants. RAI was strongly associated with HIV-1 in men (adjusted odds ratio (aOR) 3.8; 95% CI 2.0 to 6.9) and independently associated with syphilis in women (aOR 12.9; 95% CI 3.4 to 48.7).

Conclusions: High-risk adults recruited for HIV-1 prevention trials carry a high STI burden. Symptom-directed treatment may miss many cases and simple laboratory-based screening can be done with little cost. Risk assessment should include questions about anal intercourse and whether condoms were used. STI screening, including specific assessment for anorectal disease, should be offered in African research settings recruiting participants at high risk of HIV-1 acquisition.

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Footnotes

  • Funding: Financial support for this study was provided by the International AIDS Vaccine Initiative (IAVI), New York, USA, and included support from the US Agency for International Development (USAID). The University of Washington Center for AIDS Research also provided support for ongoing research and clinic infrastructure. MLG was supported by a postdoctoral student fellowship, United Saving Banks foundation, The Netherlands, and a stipend from IAVI, and SMG by NIH grant K23 AI069990-01.

  • Competing interests: None.

  • Ethics approval: The National Ethical Review Committee of the Kenya Medical Research Institute approved this study.

  • Contributors: MLG and SMG drafted the manuscript. MLG, EJS and ADS conducted the analysis. EJS, RSM and SMG established the STI screening for the cohort. MM, PG, SM, LW, HO and MAP provided input into protocol development and valuable comments on the manuscript.

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