Risk Factors for Incidence of Sexually Transmitted Infections Among Women in a Human Immunodeficiency Virus Chemoprevention Trial: VOICE (MTN-003).
In sub-Saharan Africa, there are limited data on the incidence of sexually transmitted infections (STIs) among women, largely because routine screening for asymptomatic infection is not performed. We conducted a secondary analysis to measure STI incidence rates and determine risk factors for new STI acquisition among women enrolled in the VOICE trial.



We analyzed data from 4843 women screened for chlamydia, gonorrhoea, syphilis, and trichomonas infection at baseline, annually, at interim visits when clinically indicated and at their study termination visit. Risk reduction counseling and condoms were provided throughout the trial.



Twenty percent of evaluable participants had one or more curable STIs at baseline. Over 5660 person-years at risk (PYAR) of observation, incidence rates were 13.8% (95% confidence interval [CI], 12.7-14.8) PYAR for chlamydia, 3.5% (95% CI, 3.0-4.1) PYAR gonorrhea, 0.1% (95% CI, 0.6-1.1) PYAR syphilis, and 6.6% (95% CI, 5.8-7.2) PYAR trichomoniasis. South African sites had the highest incidence of chlamydia. The Uganda site had the highest incidence of gonorrhoea and syphilis, and Zimbabwe the lowest incidence overall. The majority of these cases were diagnosed at a routine scheduled testing visit. In multivariate analysis, positive baseline STI, younger than 25 years, being unmarried, and some alcohol consumption were associated with acquiring a new STI.



We observed high rates of STIs during follow up among women in the VOICE study. Women living in human immunodeficiency virus endemic countries should be screened for common STIs.
From the *University of Zimbabwe-University of California San Francisco Research Program, Harare, Zimbabwe; †SCHARP at Fred Hutchinson Cancer Research Center; ‡Department of Biostatistics, University of Washington, Seattle, WA; §Magee-Women's Research Institute, Pittsburgh, PA; ¶Medical Research Council, HIV Prevention Research Unit, Durban, South Africa; ∥CAPRISA-University of KwaZulu Natal, Durban, South Africa; **MU-JHU Research Collaboration, Kampala, Uganda; ††Division of AIDS/NIAID/US National Institutes of Health, Bethesda, MD; ‡‡University of Pittsburgh, Pittsburgh, PA; and §§University of Alabama at Birmingham, AL.
Zvavahera Mike
ZM
Chirenje
Holly M
HM
Gundacker
Barbra
B
Richardson
Lorna
L
Rabe
Zakir
Z
Gaffoor
Gonasagrie Lulu
GL
Nair
Brenda Gati
BG
Mirembe
Jeanna M
JM
Piper
Sharon
S
Hillier
Jeanne
J
Marrazzo
D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D018890:Chemoprevention; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D011446:Prospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology