Restricted accessResearch articleFirst published online 2021-6
Quantifying geographical diversity in sexually transmitted infections using population attributable risk: results from HIV prevention trials in South Africa
In this study, we investigated spatial diversities of sexually transmitted infections (STIs) and quantified their impacts on the STIs using population attributable risk (PAR%). The study population was 7,557 women who participated in several HIV prevention trials from KwaZulu-Natal, South Africa. Our results provide compelling evidence for substantial geographical diversities on STI incidence rates in the region. Their population-level impacts on the STIs exceeded the combined impacts of the individual risk factors considered in this study (PAR%: 41% (<25 years), 52% (25-34 years) and 34% (35+ years). When all these factors are considered together, PAR% was the highest among younger women (PAR%: 67%, 82% and 50% for <25, 25-34 and 35+ years old respectively). Results from our study will bring greater insight into the previous research by increasing our understanding of the impacts of the sub-geographical level variations of STI prevalence and incidence rates in the region.
Global health sector strategy on sexually transmitted infections 2016–2021. Towards ending STIs (Report No.: WHO/RHR/16.09). Geneva: World Health Organization, 2016.
2.
Joint United Nations Program on HIV/AIDS (UNAIDS). Global AIDS update. Geneva: UNAIDS, 2018.
3.
AdachiKNielsen-SainesKKlausnerJD. Chlamydia trachomatis infection in pregnancy: the global challenge of preventing adverse pregnancy and infant outcomes in Sub-Saharan Africa and Asia. BioMed Res Int2016; 2016: Article ID 9315757. DOI: 10.1155/2016/9315757.
4.
MoodleyDMoodleyPSebitloaneM, et al.High prevalence and incidence of asymptomatic sexually transmitted infections during pregnancy and postdelivery in KwaZulu Natal, South Africa. Sexual Transmit Dis2015; 42: 43–47.
5.
MayerKHde VriesH. HIV and sexually transmitted infections: responding to the “newest normal.” J Int AIDS Soc2018; 21: e25164.
6.
MayerKHVenkateshKK. Interactions of HIV, other sexually transmitted diseases, and genital tract inflammation facilitating local pathogen transmission and acquisition. Am J Reprod Immunol2011; 65: 308–316.
7.
LewisDA. Detection and management of acute HIV infections in patients with sexually transmitted infections: a window of opportunity for HIV prevention within South Africa?South Afr J Epidemiol Infect2012; 27: 149–155.
8.
JohnsonLFCoetzeeDJDorringtonRE. Sentinel surveillance of sexually transmitted infections in South Africa: a review. Sex Transm Infect2005; 81: 287–293.
9.
McCormackSRamjeeGKamaliA, et al.PRO2000 vaginal gel for prevention of HIV-1 infection (Microbicides Development Programme 301): a phase 3, randomized, double-blind, parallel-group trial. Lancet2010; 376: 1329–1337. DOI: 10.1016/S0140-6736(10)61086-0.
10.
Skoler-KarpoffSRamjeeGAhmedK, et al.Effiacy of Carraguard for prevention of HIV infection in women in South Africa: a randomized, double-blind, placebo-controlled trial. Lancet2008; 372: 1977–1987. doi: 10.1016/S0140-6736(08)61842-5.
11.
PadianNSvan der StratenARamjeeG, et al.Diaphragm and lubricant gel for prevention of HIV acquisition in southern African women: a randomized controlled trial. Lancet2007; 370: 251–261. doi: 10.1016/S01406736(07)60950-7.
12.
MayerKHMimiagaMJGelmanM, et al.Raltegravir, tenofovir DF, and emtricitabine for postexposure prophylaxis to prevent the sexual transmission of HIV: safety, tolerability, and adherence. J Acquir Immune Defic Syndr2012; 59: 354–359. doi: 10.1097/QAI.0b013e31824a03b8
13.
MarrazzoJMRamjeeGRichardsonBA, et al.Tenofovir-based preexposure prophylaxis for HIV infection among African women. New Eng J Med2015; 372: 509–518.
14.
BaetenJMPalanee-PhillipsTBrownER, et al.Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. N Engl J Med2016; 375: 2121–2132. doi: 10.1056/NEJMoa1506110.
15.
TanserFOliveiraTMaheu-GirouxM, et al.Concentrated HIV sub-epidemics in generalized epidemic settings. Curr Opin HIV AIDS2014; 9: 115–125. doi: 10.1097/COH.0000000000000034.
16.
WandHRamjeeG. Targeting the hotspots: investigating spatial and demographic variations in HIV infection in small communities in South Africa. J Int AIDS Soc2010; 13: 41.
17.
WandHRamjeeG. Combined impact of sexual risk behaviors for HIV seroconversion among women in Durban, South Africa: implications for prevention policy and planning. AIDS Behav2011; 15: 479–486.
18.
StreetRReddyTRamjeeG. The generational effect on age disparate partnerships and the risk for human immunodeficiency virus and sexually transmitted infections acquisition. Int J STD AIDS2015; 29: 746–752.
19.
MartinHRichardsonBNyangeP, et al.Vaginal Lactobacilli, microbial flora, and risk of human immunodeficiency virus type 1 and sexually transmitted disease acquisition. J Infect Dis1999; 180: 1863–1868.
20.
McClellandRSangareLHassanW, et al.Infection with Trichomonas vaginalis increases the risk of HIV-1 acquisition. J Infect Dis2007; 195: 698–702.
21.
MlisanaKNaickerNWernerL, et al.Symptomatic vaginal discharge is a poor predictor of sexually transmitted infections and genital tract inflammation in high-risk women in South Africa. J Infect Dis2012; 206: 6–14.
22.
NaidooSWandHAbbaiNS, et al.High prevalence and incidence of sexually transmitted infections among women living in Kwazulu-Natal, South Africa. AIDS Res Ther2014; 11: 31.
23.
WoodSN. Stable and efficient multiple smoothing parameter estimation for generalized additive models. J Am Stat Assoc2004; 99: 673–686.
24.
BalkusJEBrownEPalaneeT, et al.An empiric HIV risk scoring tool to predict HIV-1 acquisition in African women. J Acquir Immune Defic Syndr2016; 72: 333–343.
25.
WandHReddyTNaidooS, et al.A simple risk prediction algorithm for HIV transmission: results from HIV prevention trials in KwaZulu Natal, South Africa (2002–2012). AIDS Behav2018; 22: 325–336. doi: 10.1007/s10461-017-1785-7
26.
WandHRamjeeG. The effects of injectable hormonal contraceptives on HIV seroconversion and on sexually transmitted infections. AIDS2012; 26: 375–380. doi: 10.1097/QAD.0b013e32834f990f
27.
MetcalfCAMalotteCKDouglasJM. Efficacy of a booster counseling session 6 months after HIV testing and counseling: a randomized, controlled trial (RESPECT-2). Sex Transm Dis2005; 32(2): 123–129.
28.
KalichmanSCCainDEatonL, et al.Randomized clinical trial of brief risk reduction counseling for sexually transmitted infection clinic patients in Cape Town, South Africa. Am J Public Health2011; 101: e9–e17. doi: 10.2105/AJPH.2011.300236.
29.
BrookmeyerKAHogbenMKinseyJ. The role of behavioral counseling in STD prevention program settings. Sex Transm Dis2016; 43: S102–S112. doi: 10.1097/OLQ.0000000000000327.
30.
PoselDR. Intra-family transfers and income-pooling a study of remittances in KwaZulu-Natal. S Afr J Econ2001; 69: 3. doi: 10.1111/j.1813-6982.2001.tb00023.x
31.
PoselDRRoganM. Women, income and poverty: gendered access to resources in Post-Apartheid South Africa. Agenda2009; 23: 25–34.
32.
DunkleK. Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection. Soc Sci Med2004; 59: 1581–1592.
33.
ReynoldsZGottertALubenE, et al.Who are the male partners of adolescent girls and young women in Swaziland? Analysis of survey data from community venues across 19 DREAMS districts. PLoS One2018; 13: e0203208. doi: 10.1371/journal.pone.0203208.
34.
de OliveiraTKharsanyABGräfT, et al.Transmission networks and risk of HIV infection in KwaZulu-Natal, South Africa: a community-wide phylogenetic study. Lancet HIV2017; 4: e41–e50.
35.
LukeN. Age and economic asymmetries in the sexual relationships of adolescent girls in sub-Saharan Africa. Stud Fam Plann2003; 34: 67–86.
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