High burden of STIs among HIV-infected adults prior to initiation of ART in South Africa: a retrospective cohort study.
OBJECTIVE
To assess the burden of sexually transmitted infections (STIs) among HIV-positive South Africans in the period prior to antiretroviral therapy (ART) initiation compared with the period once on ART.


METHODS
We linked the clinic records of 1465 patients currently on ART to the electronic database which records all visits to city clinics. We used a mixed effects Poisson model to assess the relative rates of occurrence of treatment seeking for an STI in the periods prior to initiation of ART and while on ART.


RESULTS
We accumulated 4214 person-years of follow-up, divided nearly equally between the pre-ART and on-ART periods. The rate of treatment seeking for new STIs was 5.50 (95% CI 5.43 to 5.78) per 100 person-years, and individuals had on average a sevenfold higher rate of seeking treatment for STIs in the period prior to initiating ART (9.57 per 100 person-years) compared with the period once on ART (5.5 per 100 person-years) (adjusted rate ratio (RR) 7.01, 95% CI 4.64 to 10.59). Being male (RR 1.73, 95% CI 1.18 to 2.55) or younger (age <25) (RR 2.67, 95% CI 1.53 to 4.65) was associated with higher incidence of clinic visits for STI treatment, while advanced stage of HIV disease (WHO stage 4) (RR 0.33, 95% CI 0.15 to 0.69) was associated with lower incidence.


CONCLUSIONS
The period prior to the initiation of ART is a critical period where increased attention should be focused on the detection and treatment of STIs. A successful effort to treat STIs in this period will likely reduce further HIV transmission and fits within a test-and-treat approach.
Brown University School of Public Health, Providence, Rhode Island, USA.
Mark N
MN
Lurie
Brown University School of Public Health, Providence, Rhode Island, USA Department of Epidemiology and Nutrition, Moi University School of Public Health, Eldoret, Kenya.
Kipruto
K
Kirwa
Health Information and Technology, City Health, Cape Town, South Africa.
Johann
J
Daniels
Health Information and Technology, City Health, Cape Town, South Africa.
Marcel
http://orcid.org/0000-0002-8162-3538
M
Berteler
Department of Psychology, University of Connecticut, Storrs, Connecticut, USA.
Seth C
SC
Kalichman
Health Systems Research Unit, South African Medical Research Council; and the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Catherine
C
Mathews
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
Africa; Anteretroviral Therapy; HIV