title: Improved treatment services significantly reduce the prevalence of sexually transmitted diseases in rural Tanzania: results of a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the impact of improved case management for sexually transmitted diseases (STD) at the primary health care level on the incidence and prevalence of STD.
  
  
  METHODS
  Community-randomized controlled trial.
  
  
  METHODS
  Mwanza region, Tanzania.
  
  
  METHODS
  A random cohort of about 1000 adults aged 15-54 years from each of 12 communities, in six matched pairs. One member of each pair was assigned at random to receive the intervention, and the others served as a comparison community. This cohort was surveyed at baseline and at follow-up 2 years later. About 100 antenatal clinic attenders were also studied in each community on two occasions: the first shortly after the implementation of the intervention, and the second approximately 1 year later.
  
  
  METHODS
  Improved services were established for the management of STD, using the syndromic approach, in rural health units.
  
  
  RESULTS
  A total of 12,534 individuals were enrolled in the cohort study, of whom 8844 (71%) were seen again 2 years later. The prevalence of serological syphilis (rapid plasma reagin titre > or = 1:8, Treponema pallidum haemagglutinin assay positive) was 6.2% in both intervention and comparison communities at baseline. At follow-up it was 5.0% in the intervention community and 7.0% in the comparison community [adjusted relative risk (RR), 0.71; 95% confidence interval (CI), 0.54-0.93; P < 0.02]. The prevalence of urethritis in males did not differ significantly between intervention and comparison groups at follow-up, but the prevalence of symptomatic urethritis was reduced by about 50% (adjusted RR, 0.51; 95% CI, 0.24-1.10; P = 0.08). There was no significant difference between the groups in the incidence of self-reported STD symptoms over the last year of the follow-up period, or in the prevalence of any STD in antenatal clinic attenders.
  
  
  CONCLUSIONS
  The reduction in HIV incidence previously reported in this intervention study can be attributed to a reduction in the duration, and hence the prevalence of symptomatic STD.
authors.affiliation: London School of Hygiene and Tropical Medicine, UK.
authors.forename: P
authors.initials: P
authors.lastname: Mayaud
authors.forename: F
authors.initials: F
authors.lastname: Mosha
authors.forename: J
authors.initials: J
authors.lastname: Todd
authors.forename: R
authors.initials: R
authors.lastname: Balira
authors.forename: J
authors.initials: J
authors.lastname: Mgara
authors.forename: B
authors.initials: B
authors.lastname: West
authors.forename: M
authors.initials: M
authors.lastname: Rusizoka
authors.forename: E
authors.initials: E
authors.lastname: Mwijarubi
authors.forename: R
authors.initials: R
authors.lastname: Gabone
authors.forename: A
authors.initials: A
authors.lastname: Gavyole
authors.forename: H
authors.initials: H
authors.lastname: Grosskurth
authors.forename: R
authors.initials: R
authors.lastname: Hayes
authors.forename: D
authors.initials: D
authors.lastname: Mabey
mesh_terms: D000293:Adolescent; D000328:Adult; D019090:Case Management; D015331:Cohort Studies; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D019035:Rural Health Services; D012424:Rural Population; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000628:therapy*; D013587:Syphilis / Q000453:epidemiology / Q000628:therapy; D013636:Tanzania / Q000453:epidemiology; D014526:Urethritis / Q000453:epidemiology / Q000628:therapy