Search

Objectives Trichomonas vaginalis is the most prevalent curable STI worldwide and has been associated with adverse health outcomes and increased HIV-1 transmission risk. We conducted a cross-sectional analysis among couples to assess how characteristics of both individuals in sexual partnerships are associated with the prevalence of male and female T. vaginalis infection. Methods African HIV-1 serodiscordant heterosexual couples were concurrently tested for trichomoniasis at enrolment into two clinical trials. T. vaginalis testing was by nucleic acid amplification or culture methods. Using Poisson regression with robust standard errors, we identified characteristics associated with trichomoniasis. Results Among 7531 couples tested for trichomoniasis, 981 (13%) couples contained at least one infected partner. The prevalence was 11% (n=857) among women and 4% (n=319) among men, and most infected individuals did not experience signs or symptoms of T. vaginalis . Exploring concordance of T. vaginalis status within sexual partnerships, we observed that 61% (195/319) of T. vaginalis -positive men and 23% (195/857) of T. vaginalis -positive women had a concurrently infected partner. In multivariable analysis, having a T. vaginalis -positive partner was the strongest predictor of infection for women (relative risk (RR) 4.70, 95% CI 4.10 to 5.38) and men (RR 10.09, 95% CI 7.92 to 12.85). For women, having outside sex partners, gonorrhoea, and intermediate or high Nugent scores for bacterial vaginosis were associated with increased risk of trichomoniasis, whereas age 45 years and above, being married, having children and injectable contraceptive use were associated with reduced trichomoniasis risk. Additionally, women whose male partners were circumcised, had more education or earned income had lower risk of trichomoniasis. Conclusions We found that within African HIV-1 serodiscordant heterosexual couples, the prevalence of trichomoniasis was high among partners of T. vaginalis -infected individuals, suggesting that partner services could play an important role identifying additional cases and preventing reinfection. Our results also suggest that male circumcision may reduce the risk of male-to-female T. vaginalis transmission.

African HIV-1 serodiscordant heterosexual couples were concurrently tested for trichomoniasis at enrolment into two clinical trials.Among 7531 couples tested for trichomoniasis, 981 (13%) couples contained at least one infected partner. The prevalence was 11% (n=857) among women and 4% (n=319) among men, and most infected individuals did not experience signs or symptoms ofWe found that within African HIV-1 serodiscordant heterosexual couples, the prevalence of trichomoniasis was high among partners of

Objectives: Attitudes and practices concerning genital hygiene may influence topical microbicide use by men. This study examines knowledge and behaviours related to hygiene, genital hygiene, circumcision and hygiene, and to genital hygiene before and after sex among men in Nairobi, Kenya. Methods: We conducted 463 interviews of men recruited by respondent driven sampling techniques and 10 focus group discussions with a subsample of 100 volunteers from this group. Men were asked individual quantitative survey and qualitative group discussion questions about general hygiene behaviours, genital hygiene, and the temporal relation of genital hygiene behaviours to sexual encounters. Results: Bathing once daily was associated with education, income, and inside tap water. Genital washing aside from regular bathing and washing before sex ever were negatively associated with bathroom crowding. Genital hygiene before the most recent sexual encounter was uncommon and negatively associated with HIV risk perception, bathroom crowding, and ethnicity. Men believed genital hygiene before sex would arouse suspicions of infidelity or cool sexual ardour. Genital hygiene after sex was associated with education, religion, and having inside tap water. Genital hygiene after the most recent sexual encounter was associated with age, income, and with men having at least one child. Conclusions: Genital hygiene behaviours were associated with resource access factors and group discussions suggest that they are modulated by interactions in sexual partnerships. Topical microbicides may improve hygiene before and after sex.

Objectives To assess vaginal cleansing and lubricant use among female sex workers (FSW) in Kenya participating in a 6-month, prospective study of the acceptability of the use of the diaphragm. Methods The study is based on 140 FSW in Nairobi, who completed 140 baseline visits and 390 bi-monthly follow-up visits. Participants were instructed to wear the diaphragm for all coital acts during follow-up and to refrain from vaginal cleansing while wearing the diaphragm. Logistic regression was used to identify predictors of recent vaginal cleansing to ‘tighten’ the vagina reported at baseline; recent vaginal cleansing to prevent infection reported at baseline; recent vaginal cleansing with the diaphragm in place reported during follow-up; and recent use of oil-based lubricant during coitus reported at baseline. Results At baseline, 99% of women reported vaginal cleansing in the previous 2 weeks for purposes of hygiene or to remove evidence of past coitus. Approximately 41% of women also reported cleansing in the past 2 weeks to ‘tighten’ the vagina. Women reported vaginal cleansing with the diaphragm in place in the past 2 weeks at 14% of follow-up visits in which the diaphragm was used. Predictors of such cleansing included young age, 6-month study visit, being divorced or widowed and higher educational level. Conclusions While vaginal cleansing is a modifiable behaviour, given that cleansing for hygiene was almost universal among this study population at baseline and that more women reported cleansing while wearing the diaphragm as the study progressed, the complete eradication of the practice would probably be difficult.

Objectives: To determine the prevalence and correlates of herpes simplex virus type 2 (HSV-2) seropositivity among fishermen along the shores of Lake Victoria in Kisumu district, Kenya. Methods: Sera from a random sample of 250 fishermen from 18 beaches were collected after a detailed sociodemographic interview. HSV-2 infection was tested by Kalon HSV-2 ELISA. Results: The HSV-2 seroprevalence was 63.9%. In multivariate analysis, fishermen were more likely to be infected with HSV-2 if they were HIV positive (prevalence ratio (PR) 1.27; 95% CI 1.06 to 1.52) compared with those testing HIV negative, were aged 18–20 (PR 0.49; 95% CI 0.24 to 0.99) and older than 40 (PR 1.66; 95% CI 1.30 to 2.14) years compared with those aged 21–25 years, perceived their last two sexual partners to have a sexually transmitted infection (STI; PR 1.27; 95% CI 1.06 to 1.52) compared with those who did not and were more likely to be circumcised (PR 1.49; 95% CI 1.19 to 1.86). Conclusions: HSV-2 seroprevalence is high among this population and is associated with HIV serostatus, age, perception about partner’s STI status and circumcision.

Objectives: The epidemiology of human papillomavirus (HPV) infection in men in Kenya is largely uncharacterised. We set out to determine the prevalence and determinants of HPV infection among sexually active fishermen along Lake Victoria in the Kisumu district of Kenya. Methods: Genital swabs were obtained from 250 consenting fishermen from 18 beaches and a detailed sociodemographic questionnaire was administered. HPV positivity was determined by polymerase chain reaction amplification and detected by dot blot hybridisation with generic HPV and β-globin probes. HPV positive samples were genotyped using the Roche Linear array assay. Results: Overall, 144 (57.6%) fishermen had detectable HPV DNA, 106 (42.4%) were infected with oncogenic HPV types, with HPV-16 being the most frequent type (12.4%). Among HPV positive men, 105 (72.9%) were infected with more than one HPV type and 20 (13.9%) were infected with more than six different types. HIV seropositive men (PR 1.49, 95% CI 1.19 to 1.86) and those divorced or separated (PR 1.62, 95% CI 1.13 to 2.33) were more likely to be infected with HPV. HIV infection (PR 1.22, 95% CI 1.01 to 1.47) was the only factor independently associated with infection with multiple types of HPV. Conclusion: The prevalence of oncogenic HPV infection is high among this population and is associated with HIV serostatus and marital status. This community could benefit from enhanced sexually transmitted infection and HIV prevention interventions.

Background Prompt linkage to care, retention in care and adherence to medication are important in achieving the WHO’s 90–90–90 treatment target. Achieving these targets is important for treatment and prevention of new infections. We sought to establish the time to linkage to care, retention in care and adherence to HIV medications in a cohort of people testing HIV positive in the fishing communities on Lake Victoria. Methods We conducted a 2-year resurvey of 128 participants who had tested HIV positive in a previous study. These participants were asked to return to the study clinic to participate in a follow-up study. Returning participants were consented and invited for a face-to-face interview on enrolment into HIV care, time to enrolment, retention in care and adherence to HIV care instructions. We mainly used descriptive statistics to analyse the data. Results Of 128 participants, 47.7% were female and half were aged 33.5 (IQR, 29–38.7) with a median monthly income of $66 (IQR, 33–99). Eighty three percent had enrolled in HIV care within a median of 20 days (IQR, 7–60) after testing HIV positive. Women were more likely to enrol in care compared to men (91.8% vs 74.6%; p = 0.011) but no significant difference in time taken to enrol in care. Over 38% of the participants had ever missed their clinic appointments since they first enrolled into care with half having missed 2 appointments (IQR, 1–3.5) in the preceding 12 months. Similarly, 26% had ever missed taking medications as prescribed with half having missed twice (IQR, 1–8.5) in the preceding 12 months. The most common reason cited for both missing clinic appointments and taking medications prescribed was travelling away from home. Conclusion The numbers enrolled into care falls below the expected 90% to achieve 90–90–90 treatment target by WHO. More innovative ways need to be developed to achieve these targets. Disclosure of interest statement This research was supported by a grant from the Consortium for National Health Research. No pharmaceutical grants were received in the development of this study.

Background Men with high-risk sexually behaviour are important drivers of HIV/STI infections in the general population. Prevention of HIV/STIs among such men could potentially reduce these infections especially among women - who bear the greatest HIV/STIs disease burden in sub Saharan Africa. We sought to understand immunovirology of HPV infections among fishermen. This evaluation highlights the rate of HIV infections in this population. Methods Three hundred fishermen were recruited and followed up every 3 months for 1 year. HIV, syphilis serology, CD4/CD8 and complete blood count were evaluated and a demographic questionnaire administered. Data was analysed by SPSS ver18. Results The 300 men recruited into this study had mean age of 28 years, 76% were married and 57% had only basic education. The mean for age of sexual debut and lifetime sexual partners was 15 years and 10 respectively. They had a modal sexual activity of 3 times/week and a mean of 3 rounds/sexual act. Sixty one (20%) had practised oral sex. Thirty six (12%) and 80 (27%) of men washed their genitals, before and after sex respectively. A significant number of men; 183 (61%) P Conclusion Fishermen in this context, comprise a young sexually high-risk, highly-migratory population with high HIV incidence and prevalence. Low condom use coupled with concurrent multiple sexual partnerships make them a potential key population who require targeted prevention strategies to reduce HIV/STI infections and transmission.

Objectives The Human Immunodeficiency Virus (HIV) is a retro-virus that attacks the immune system of the host individual, slowly invading and killing T-cells. As the disease progresses, individuals become increasingly susceptible to other illnesses. Eventually usually within 7 to 10 years the compromised immune system will lead to death through another proximate cause. An individual is said to have (AIDS) once their immune system has been severely compromised. Methods The most common channels of transmission are sexual; the other major type of transmission is vertical from mother to child either in the womb, during birth, or while breastfeeding. HIV can also be spread through sharing needles (either by intravenous drug users, or poor hygiene in hospitals) and through transfusions with infected blood. Results The efficiency of these transmission mechanisms varies. Infection rates are higher for anal than vaginal sex, higher still for mother-to-child transmission, and extremely high (close 100 percent) for transfusion with infected blood. Drugs that dramatically slow the progression of HIV have become available in recent years. Use of these regimens in the developing world is rare, due both to the cost of the drugs (even in generic form) and the difficulty of administering daily drug cocktails on a continent with few doctors. Conclusions Interventions in Africa have focused more on prevention and treatment of opportunistic infections, including prevention of mother-to-child transmission, education about changes in sexual behaviour, treatment of other sexually transmitted infections (STIs) and treatment of tuberculosis and other disease associated with HIV/AIDS.

Background Inaccurate suspicions of infidelity among married couples can affect trust and intimacy in a relationship. We sought to establish the prevalence, accuracy and correlates of infidelity suspicions among married couples. Methods We conducted a cross-sectional survey of 545 couples. We contacted a proportion to size simple random sample of fishermen on each beach as our index participants and asked them to enrol with their spouses. The consenting couples were separated into different private rooms for simultaneous gender-matched interviews. In addition to socio-economic and behavioural data, we collected information on extra-marital sex partners and infidelity suspicions among spouses. We used descriptive statistics and multivariate logistic regression for analysis. Results A quarter (27.2%) of the women and 16.9% of the men suspected their spouses of infidelity but only 6.2% of the women and 32.1% of the men reported extra-marital relationship. Overall, 43.2% of the women and 6.5% of the men accurately suspected their spouses with sensitivity of 36.6% and 17.6% respectively. Correlates of women accurately suspecting their spouses were: men being mobile (OR, 0.58; 95% CI: 0.39–0.85), couple being in polygamous marriage (OR, 0.48; 95% CI: 0.25–0.90), taking longer time during sexual intercourse (OR, 0.97; 95% CI: 0.95–0.99), men’s higher score on male dominance sex roles (for all our scales, higher score better) (OR, 1.08; 95% CI: 1.03–1.13) and higher score on domestic violence scale (OR, 1.27; 95% CI: 1.12–1.44). Conversely, correlates of men accurately suspecting their spouses of infidelity were: women being denied preferred sex position (OR, 0.50; 95% CI: 0.26–0.98), couple being in polygamous marriage (OR, 2.51; 95% CI: 1.01–6.23) and higher score on domestic violence - higher e scale (OR, 1.33; 95% CI: 1.15–1.54). Conclusion High rates of inaccurate infidelity suspicions in this community may be detrimental to marital relationships. Couples need to consider correlates that aid accurate suspicion before bring up the issue for discussion.

Background Human immunodeficiency virus (HIV) and Treponema pallidum share modes of transmission. Congenital syphilis is a significant cause of stillbirth, prenatal death and serious neonatal infections. We sought to evaluate rapid test kit for HIV-syphilis dual detection to improve diagnosis and enable accurate management towards achieving the renewed zeal of eradicating syphilis and congenital syphilis. Methods Six hundred and eighty serum specimens from HIV discordant couples in a clinical trial, tested for syphilis infection by RPR with reactive specimens confirmed by TPHA, were used for this evaluation. HIV status was determined by Uni-Gold™ and Determine™ HIV rapid kits and all positive samples confirmed by two HIV Enzyme immunoassay test. These specimens were blindly retested using the HIV-Syphilis Duo kit. Results Of 698 samples evaluated 139 (20%) were RPR positive and 346 (50%) were HIV positive. Among the RPR positive, 85 (61%) were TPHA positive. None of 559 RPR negative samples tested syphilis positive on HIV-Syphilis Duo kits. Of the 85 RPR positive-TPHA positive samples, none tested syphilis negative on the HIV-Syphilis Duo kit. All RPR positive-TPHA negative samples tested syphilis negative on the HIV-Syphilis Duo kit. Sensitivity and specificity was: both 100% for syphilis detection and; 99.71% and 100% respectively for HIV detection. On this sample set the Sensitivity of Determine™ and Uni-Gold™ was 96.82% and 98.27% respectively while the Specificity was 93.75% and 99.43% respectively. HIV-Syphilis Duo kit detected 5 early HIV infections that were missed out by Determine™ and Uni-Gold™ at least one month prior to a seroconversion visit. Conclusion HIV-Syphilis DUO test kit performed better compared to RPR for syphilis and Determine™ for HIV detection. It was equivalent to TPHA for syphilis and Uni-Gold™ for HIV detection. Its implementation in antenatal clinics/VCTs will present an added opportunity for simultaneous diagnosis of HIV and syphilis.

Background Factors influencing choice and use of contraceptives among HIV discordant couples have important policy and programmatic implications for HIV and pregnancy prevention. We investigated factors among women and men in an HIV serodiscordant couple enrolled in a phase 3 clinical trial of Partners PrEP study. Methods Prospective sub-study enrolled 385 men and women selected from 629 couples. Family planning counselling and contraceptives were offered to participants at each visit. Questionnaires were administered at enrolment and after 6 months and 12 months to document contraceptive knowledge, preference and use. A logistic generalised estimating equation was used. IRB reviewed written consents. Results The average age was 28.5 years (SD = 8.5) for female and 34.9(SD = 10.3) years for males. The median number of children was 1(IQR = 0–3). At baseline, knowledge of contraceptives was 99% for both men and women, and 143 (37%) reported current use of any contraceptive (male condoms = 50%, injectables = 31%, implants = 9%, oral pills = 4%, other = 6%). Of the 242 not using contraceptives at baseline, 182 (75%) wanted to use a contraceptive; 98 (54%) of them specified their preferences including 52% injectables, 22% male condoms, 11% oral pills, 9% implants and 6% other. At 6 month follow-up 302 (78%) and 12-month follow-up visit 274 (71%) reported use of contraception; an increased odds (OR = 1.74, 95% CI = 1.64–3.53; OR = 1.74, 95% CI = 1.20–2.53, respectively) of contraceptive use over baseline HIV-negative participants were more likely to use contraception (including condoms) than HIV-positive participants (OR = 1.49.95% CI (1.05–2.01). Odds of contraceptive use rose with the number of children one had (OR = 1.09, 95% CI 1.00–1.19). Main reason for not using contraceptives during follow up was fear of side effects (OR = 0.49, 95% CI 0.44–0.55). Conclusion Education and counselling provided at this site led to an almost doubling of contraceptive usage among HIV serodiscordant couples. Policymakers can adopt this to address gap between knowledge and usage.

Background Recruitment of participants into large clinical trials may be challenging and costly. Utilization of limited resources to maximise the yield is crucial. We sought to compare costs of different recruitment strategies. Methods To recruit 600–800 HIV discordant couples, we explored different recruitment strategies: referrals from voluntary HIV counselling and testing (VCT) centres and Home based counselling and testing (HBCT) and referrals from participants involved in a previous clinical trial. In the three strategies, we implemented accelerated mobilisation through public address system, radio talk shows and the couples ambassador model (where influential peers encourage couples HIV counselling and testing). Direct cost computation was the total amount of money spent per strategy. VCT and HBCT costs included counsellors training, cost of communication and transport reimbursement for participants’ visits. The previous study participants’ recruitment costs included communication and transport. Results Between August 2008 and October 2010, 2060 HIV discordant couples were referred for screening. VCT, 1666(80.9%) from VCT; HBCT, 345(16.7%); and 49(2.4%) by participants from earlier trial. The cost per strategy for VCT was $81,973, HBCT $ 2,300 and Previous study participants recruitment$327; the yield per strategy was VCT 440/1666(26.4%), HBCT 161/345(46.7%) and previous study participant recruitment 28/49 (57.1%). However, VCT and HBCT contributed the most to enrollment at the study site 440/629(70%) and 161/629(26%) respectively. The average cost per couple referred from VCT was $49, HBCT was $7 and previous study participant recruitment was $7. This translates to average cost of couples enrolled to $63. Conclusion VCT strategy was most costly compared to those from previous clinical trial and HBCT; however, it yielded the highest enrolment. Multiple strategies are recommended for successful recruitment. This computation does not take into account staff time for each of the strategies listed.

Background Extra-marital partnerships have been associated with the spread of STIs including HIV among married couples. We sought to establish the actor and partner effects of relationship and sexual satisfactions on extra-marital partnerships among married couples. Methods We conducted a cross-sectional survey of 545 couples. We contacted a proportion to size simple random sample of fishermen on each beach as our index participants and asked them to enrol with their spouses. The consenting couples were separated into different private rooms for simultaneous gender-matched interviews. In addition to socio-economic and behavioural data, we collected information on extra-marital sex partners as well as the scores of participants on a 7-item relationship satisfaction scale and 25-item sexual satisfaction scale. We analysed data using multilevel modelling under the framework of actor-partner interdependent model (APIM). Results Men had a median score of 56 (IQR 52–61) and women 53 (IQR 47–59) on sexual satisfaction scale. Both men and women had same median score of 16 (IQR 14–18) on relationship satisfaction scale. We found a significant partner effect of men’s relationship satisfaction on their spouses number extra-marital partnerships such that the more men are satisfied in their relationship the fewer the number of extra-marital partners their spouses report (B = –0.10; p = Conclusion Inculcating and maintaining good relationship and sexual satisfaction within couples in this community reduces their own and their partners’ number of extra-marital partnerships.

Background Control of sexually transmitting infections (STIs) is an important aspect of HIV prevention and care. Syndromic management for vaginal discharge, despite a recognised low sensitivity and specificity, is widely employed for STI management among HIV-1 infected women in resource-limited settings. In this pilot study, we evaluated the incremental increase in sensitivity and specificity of multiple, low-cost diagnostic strategies for non-ulcerative STIs diagnosed among HIV-1 infected women receiving care in Kenya. Methods This cross-sectional study was done among a cohort of HIV-1 infected women enrolled at Family AIDS and Care and Treatment Services (FACES) clinics in Kisumu, Kenya. During their routine clinic visit, participants reported any health complaint and later were asked about general vaginal symptoms (brief symptom ascertainment) and specific complaints of pruritis, odour and discharge (detailed symptom ascertainment). Clients were then examined for cervicitis and vaginal discharge, followed by specimen collection for STI testing. Results of Chlamydia trachomatis and Neisseria gonorrhoeae nucleic acid amplification test and Trichomonas vaginalis (TV) by wet mount was used as the gold standard for sensitivity and specificity calculations. Results Of the 155 women who were screened between the ages of 23–53 years, the prevalence of N gonorrhoeae was 1.9% (3/155), TV was 6.4% (10/155) and no cases of C trachomatis were detected. See Abstract P3-S1.08 table 1. Conclusions Syndromic management had a very poor sensitivity for detecting STIs in HIV-1 infected women. The addition of specific questions about STI-related symptoms improved STI detection rates, while a speculum exam led to greater sensitivity and specificity. The feasibility and effectiveness of alternative approaches such as routine use of speculum exams, and point-of-care testing for T vaginalis should be explored to improve the management of STIs among HIV-1 infected women in similar low-resource settings.

Background Daily suppressive therapy with valacyclovir reduces the risk of sexual transmission of HSV-2 in healthy HSV-2 serodiscordant heterosexual couples by 48%. Whether suppressive therapy reduces HSV-2 transmission from persons who have both HIV-1 and HSV-2 is unknown. Methods Within a randomised trial of daily acyclovir 400 mg bid in African HIV-1 serodiscordant couples, in which the HIV-1 infected partner was HSV-2 seropositive, we identified partnerships in which the HIV-1 susceptible partners were HSV-2 seronegative. Cox proportional hazards analysis was used. Results We followed 911 HIV-1 and HSV-2 serodiscordant couples for a median of 18 months (IQR 3, 24). For 112 couples (12%), the HIV-1/HSV-2 infected partner was male, of whom 37% (34/91) were circumcised. 68 HSV-2 seroconversions were observed (an incidence of 5.1 per 100 person-years): 40 in the acyclovir group and 28 in the placebo group (HR 1.4, 95% CI 0.8 to 2.2; p=0.2). In a multivariate analysis of HSV-2 susceptible women, hormonal contraception (HR 3.84, 95% CI 1.32 to 11.14, p=0.013) and having an uncircumcised male partner (HR 8.91, 95% CI 1.17 to 67.85, p=0.035) were significant risk factors for HSV-2 acquisition. Among HSV-2 susceptible men, younger age was the only significant HSV-2 risk factor (p=0.014). Conclusions Suppressive acyclovir therapy did not decrease the risk of HSV-2 transmission within HSV-2-serodiscordant couples in which the HSV-2-seropositive partner also had HIV-1 infection. Hormonal contraceptive use and lack of male circumcision in the HIV-1/HSV-2 dually infected male partners increased the risk of HSV-2 acquisition among initially HSV-2 seronegative women.