A randomized, community trial of intensive sexually transmitted disease control for AIDS prevention, Rakai, Uganda.
OBJECTIVE
To describe the design and first-round survey results of a trial of intensive sexually transmitted disease (STD) control to reduce HIV-1 incidence.


METHODS
Randomized, controlled, community-based trial in Rakai District, Uganda.


METHODS
In this ongoing study, 56 communities were grouped into 10 clusters designed to encompass social/sexual networks; clusters within blocks were randomly assigned to the intervention or control arm. Every 10 months, all consenting resident adults aged 15-59 years are visited in the home for interview and sample collection (serological sample, urine, and, in the case of women, self-administered vaginal swabs). Sera are tested for HIV-1, syphilis, gonorrhea, chlamydia, trichomonas and bacterial vaginosis. Following interview, all consenting adults are offered directly observed, single oral dose treatment (STD treatment in the intervention arm, anthelminthic and iron-folate in the control arm). Treatment is administered irrespective of symptoms or laboratory testing (mass treatment strategy). Both arms receive identical health education, condom and serological counseling services.


RESULTS
In the first home visit round, the study enrolled 5834 intervention and 5784 control arm subjects. Compliance with interview, sample collection and treatment was high in both arms (over 90%). Study arm populations were comparable with respect to sociodemographic and behavioral characteristics, and baseline HIV and STD rates. The latter were high: 16.9% of all subjects were HIV-positive, 10.0% had syphilis, and 23.8% of women had trichomonas and 50.9% had bacterial vaginosis.


CONCLUSIONS
Testing the effects of STD control on AIDS prevention is feasible in this Ugandan setting.
Wawer
M J
MJ
Columbia University, New York, New York, USA.
Gray
R H
RH
Sewankambo
N K
NK
Serwadda
D
D
Paxton
L
L
Berkley
S
S
McNairn
D
D
Wabwire-Mangen
F
F
Li
C
C
Nalugoda
F
F
Kiwanuka
N
N
Lutalo
T
T
Brookmeyer
R
R
Kelly
R
R
Quinn
T C
TC
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000517:prevention & control*; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017963:Azithromycin / Q000008:administration & dosage / Q000627:therapeutic use; D020682:Cefixime; D002439:Cefotaxime / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D015497:HIV-1; D006801:Humans; D015994:Incidence; D007273:Injections, Intramuscular; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D010401:Penicillin G Benzathine / Q000008:administration & dosage / Q000627:therapeutic use; D015995:Prevalence; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000150:complications / Q000188:drug therapy*; D016037:Single-Blind Method; D014454:Uganda / Q000453:epidemiology
D000890:Anti-Infective Agents; D008795:Metronidazole; D002939:Ciprofloxacin; D017963:Azithromycin; D020682:Cefixime; D002439:Cefotaxime; D010401:Penicillin G Benzathine