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Original research
Sexually transmitted infections and migration in Uganda: a population-based study
  1. Michelle A Moffa1,
  2. Xinyi Feng2,
  3. Josephine Mpagazi3,
  4. Stephen Kiboneka3,
  5. Robert Ssekubugu3,
  6. John Baptiste Kereba3,
  7. Annet Nakayijja3,
  8. Julius Tukundane3,
  9. Jade Jackson2,
  10. Caitlin E Kennedy4,
  11. Godfrey Kigozi3,
  12. Ronald M Galiwango3,
  13. Yukari C Manabe5,
  14. Charlotte A Gaydos5,
  15. Larry W Chang5,6,
  16. Sarah Kalibala3,
  17. Steven J Reynolds5,7,
  18. Aaron AR Tobian2,6,
  19. Thomas Quinn5,6,
  20. M Kate Grabowski2,6,
  21. Joseph Kagayi3,8
  1. 1The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  3. 3Rakai Health Sciences Program, Kalisizo, Central Region, Uganda
  4. 4International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  5. 5Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  6. 6Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  7. 7Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
  8. 8Department of Disease Control and Environmental Health, Makerere University, Kampala, Uganda
  1. Correspondence to Dr M Kate Grabowski, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; mgrabow2{at}jhu.edu

Abstract

Objectives Migration is associated with increased risk of HIV infection in Africa, but evidence about non-HIV sexually transmitted infection (STI) burden among African migrants is limited.

Methods We used data from the Sexually Transmitted Infection Prevalence Study, a cross-sectional population-based study of chlamydia, gonorrhoea, trichomoniasis, syphilis and herpes simplex virus type 2 prevalence in southern Uganda, to compare STI prevalence between adults aged 18 and 49 years with and without a recent history of migration. Migration status was determined using household census data, with a recent migration history defined as having moved into one’s community of current residence within the last ~18 months. Unadjusted and adjusted modified Poisson regression models were used to compare individual STI prevalence risk by recent migration status with associations reported as adjusted prevalence risk ratios (adjPRRs) with 95% CIs. Adjusted models included participants’ sex, age, community type, education, occupation and marital status.

Results Among 1825 participants, 358 (19.6%) had a recent migration history. Overall, migrants exhibited a significantly higher combined prevalence of curable STIs (gonorrhoea, chlamydia, high-titre syphilis (rapid plasma regain ≥1:8) and trichomoniasis) as compared with long-term residents (34.4% vs 24.2%; adjPRR=1.23; 95% CI 1.03 to 1.47). Significant differences in curable STI prevalence by migration status were concentrated among persons living with HIV (49.4% prevalence in migrants vs 32.6% in long-term residents; adjPRR=1.42; 95% CI 1.10 to 1.85) and among women (38.8% in migrants vs 27.8% in long-term residents; adjPRR=1.26; 95% CI 1.01 to 1.58). High-titre syphilis prevalence was especially elevated among male migrants (11.2% in migrants vs 4.9% in long-term residents; adjPRR=1.82; 95% CI 1.06 to 3.13).

Conclusions The prevalence of non-HIV STIs is higher among migrants. Tailored outreach and service delivery approaches that address the needs of mobile populations are crucial for integrated HIV and STI epidemic control in Uganda to optimise resources and reduce transmission risks.

  • MIGRATION
  • HIV
  • SYPHILIS
  • AFRICA

Data availability statement

Data are available upon reasonable request. All data and code are available upon reasonable request to the Rakai Health Sciences Program.

https://doi.org/10.1136/sextrans-2024-056190

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    Data availability statement

    Data are available upon reasonable request. All data and code are available upon reasonable request to the Rakai Health Sciences Program.

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    Footnotes

    • Handling editor Jane S Hocking

    • MKG and JK contributed equally.

    • Contributors MKG is the corresponding author and guarantor. MAM wrote the original draft. XF and MKG did the formal analysis. MKG, CAG, TQ, GK, SR, LWC, CEK, AT, YCM and JK conceptualised the study and contributed to the design. MKG, TQ and CAG acquired study funding. MKG, LWC, JK, GK and RS supervised the study activities. JJ, SKi and JM coordinated the study. GK, SKa and RMG supervised the laboratory activities. JM, RS, SKa, AN, JBK, JT and SKi collected the survey, clinical and laboratory data. All authors contributed to writing, reviewing and editing of the final manuscript.

    • Funding This work was supported by grants from the Johns Hopkins Center for AIDS Research (P30AI094189), the National Institute of Allergy and Infectious Diseases (R01AI143333, R01MH115799, K01AI125086), the National Institute of Mental Health (R01MH107275), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (RO1HD091003), the Division of Intramural Research of the National Institute for Allergy and Infectious Diseases, and the President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention (NU2GGH000817).

    • Competing interests YCM has received grant support to Johns Hopkins University from Hologic, Cepheid, Roche, ChemBio, Becton Dickinson and miDiagnostics, and has provided consultative support to Abbot.

    • 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.