title: Genital infections and syndromic diagnosis among HIV-infected women in HIV care programmes in Kenya.
abstract: Control of genital infections remains challenging in most regions. Despite advocacy by the World Health Organization for syndromic case management, there are limited data on the syndromic approach, especially in HIV care settings. This study compared the syndromic approach with laboratory diagnosis among women in HIV care in Kenya. A mobile team visited 39 large HIV care programmes in Kenya and enrolled participants using population-proportionate sampling. Participants provided behavioural and clinical data with genital and blood specimens for lab testing. Among 1063 women, 68.4% had been on antiretroviral therapy >1 year; 58.9% were using cotrimoxazole prophylaxis; 51 % had CD4+T-lymphocytes < 350 cells/µL. Most women (63.1%) reported at least one genital symptom. Clinical signs were found in 63% of women; and 30.8% had an aetiological diagnosis. Bacterial vaginosis (17.4%), vaginal candidiasis (10.6%) and trichomoniasis (10.5%) were the most common diagnoses. Using laboratory diagnoses as gold standard, sensitivity and positive predictive value of the syndromic diagnosis for vaginal discharge were 47.6% and 52.7%, respectively, indicating a substantial amount of overtreatment. A systematic physical examination increased by 9.3% the positive predictive value for genital ulcer disease. Women attending HIV care programmes in Kenya have high rates of vaginal infections. Syndromic diagnosis was a poor predictor of those infections.
authors.affiliation: US Centers for Disease Control and Prevention, Atlanta, GA, USA gdd7@cdc.gov.
authors.forename: Gaston
authors.initials: G
authors.lastname: Djomand
authors.affiliation: US Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Hongjiang
authors.initials: H
authors.lastname: Gao
authors.affiliation: Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Benson
authors.initials: B
authors.lastname: Singa
authors.affiliation: US Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Sureyya
authors.initials: S
authors.lastname: Hornston
authors.affiliation: US Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Eddas
authors.initials: E
authors.lastname: Bennett
authors.affiliation: DGHA, US Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: James
authors.initials: J
authors.lastname: Odek
authors.affiliation: Departments of Medicine, Epidemiology and Global Health, University of Washington, Seattle, WA, USA.
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
authors.affiliation: Departments of Medicine, Epidemiology and Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
authors.affiliation: US Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Naomi
authors.initials: N
authors.lastname: Bock
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology / Q000209:etiology*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D015995:Prevalence; D060737:Reproductive Tract Infections / Q000175:diagnosis* / Q000453:epidemiology; D012749:Sexually Transmitted Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D013577:Syndrome; D014522:Urethral Diseases / Q000453:epidemiology / Q000209:etiology*; D019522:Vaginal Discharge / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS; Genital infections; HIV; Kenya; sexually transmitted infections; syndromic management; vaginal discharge; women