The effect of a structural intervention for syphilis control among 3597 female sex workers: a demonstration study in South China.
BACKGROUND
Syphilis has made a rapid resurgence in China, especially among high-risk groups including female sex workers (FSWs).


METHODS
Two cities in each of 3 provinces in South China were chosen and allocated to intervention or control arms. The intervention consisted of enhancing community-based syphilis screening outreach intervention with comprehensive sexually transmitted infection services at designated clinics while the control maintained routine intervention activities. Generalized linear modeling was used to examine effect of the intervention on incident syphilis infection.


RESULTS
A total of 8275 women were eligible, and 3597 women enrolled (n = 2011 in control arm, n = 1586 in intervention arm) in the study. The median follow-up duration was 375 days (interquartile range, 267–475). Syphilis incidence density in the intervention group was reduced by 70% (95% confidence interval, 53%–81%) compared with the incidence in the control arm. The syphilis prevention intervention benefits were robust among FSWs at low-tier venues, individuals with less than high school education, migrants, and women who did not report condom use during the last episode of sex.


CONCLUSIONS
Integrated sexually transmitted infection and human immunodeficiency virus prevention strategies substantially reduce syphilis incidence among FSWs, especially among those at low-tier venues. This intervention suggests the need for scaling up comprehensive FSW programs in China.
National Center for STD Control, Chinese Academy of Medical Sciences & Peking Union Medical College Institute of Dermatology, China. wangbx@ncstdlc.org
Baoxi
B
Wang
Qian-Qiu
QQ
Wang
Yue-Ping
YP
Yin
Guo-Jun
GJ
Liang
Ning
N
Jiang
Xiang-Dong
XD
Gong
Bin
B
Yang
Yue-Jiao
YJ
Zhou
Qiao
Q
Liu
Xi-Ping
XP
Huan
Li-Gang
LG
Yang
Guang-Jie
GJ
Tan
Dong-Nu
DN
Pei
Joseph D
JD
Tucker
Xiang-Sheng
XS
Chen
D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D017280:Condoms; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D006266:Health Education / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D060386:Sex Workers; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult