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Pulerwitz J, Gottert A, Tun W, Eromhonsele AF, Oladimeji PL, Shoyemi E, Akoro M, Ndeloa C, Adedimeji A. Reducing stigma and promoting HIV wellness/mental health of sexual and gender minorities: RCT results from a group-based programme in Nigeria. J Int AIDS Soc 2024; 27:e26256. [PMID: 38837614 DOI: 10.1002/jia2.26256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 04/15/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION High levels of HIV stigma as well as stigma directed towards sexual and/or gender minorities (SGMs) are well documented in the African setting. These intersecting stigmas impede psychosocial wellbeing and HIV prevention and care. Yet, there are few if any evidence-based interventions that focus on reducing internalized stigma and promoting mental health and HIV wellness for SGMs in Africa. We developed and evaluated a group-based intervention drawing on cognitive behavioural therapy (CBT) strategies for men who have sex with men (MSM) and transgender women (TGW) at risk for or living with HIV in Lagos, Nigeria. METHODS The intervention comprised four weekly in-person group sessions facilitated by community health workers. We conducted a delayed intervention group randomized controlled trial (April-September 2022), with pre-post surveys plus 3-month follow-up (immediate group only), as well as qualitative research with participants and programme staff. Outcomes included internalized stigma related to SGM and HIV status, depression, resiliency/coping and pre-exposure prophylaxis (PrEP)/HIV treatment use. RESULTS Mean age of the 240 participants was 26 years (range 18-42). Seventy-seven percent self-identified as MSM and 23% TGW; 27% were people with HIV. Most (88%) participants attended all four sessions, and 98% expressed high intervention satisfaction. There was significant pre-post improvement in each psychosocial outcome, in both the immediate and delayed arms. There were further positive changes for the immediate intervention group by 3-month follow-up (e.g. in intersectional internalized stigma, depression). While baseline levels of ever-PrEP use were the same, 75% of immediate-group participants reported currently using PrEP at 3 months post-intervention versus 53% of delayed-group participants right after the intervention (p<0.01). Participants post-intervention described (in qualitative interviews) less self-blame, and enhanced social support and resilience when facing stigma, as well as motivation to use PrEP, and indicated that positive pre-intervention changes in psychosocial factors found in the delayed group mainly reflected perceived support from the study interviewers. CONCLUSIONS This study demonstrated the feasibility and acceptability of a group-based CBT model for MSM and TGW in Nigeria. There were also some indications of positive shifts related to stigma, mental health and PrEP, despite issues with maintaining the randomized design in this challenging environment.
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Affiliation(s)
- Julie Pulerwitz
- Social and Behavioural Science Research Division, Population Council, Washington, DC, USA
| | - Ann Gottert
- Social and Behavioural Science Research Division, Population Council, Washington, DC, USA
| | - Waimar Tun
- Social and Behavioural Science Research Division, Population Council, Washington, DC, USA
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Dah TTE, De Baetselier I, Cuer B, Anoma C, Mensah E, Koné A, Diandé S, Dagnra CA, Faye-Kette HY, Yeo A, Yaya I, Spire B, Keita BD, Crucitti T, Vuylsteke B, Laurent C. Frequent chlamydia and gonorrhoea but very infrequent syphilis among men who have sex with men using HIV pre-exposure prophylaxis in West Africa. Sex Transm Infect 2024; 100:201-207. [PMID: 38604698 DOI: 10.1136/sextrans-2023-056000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/13/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES Although oral pre-exposure prophylaxis (PrEP) for HIV is being rolled out in West Africa, data on sexually transmitted infections (STIs) in PrEP users are scarce. We assessed the prevalence, incidence and determinants of bacterial STIs in men who have sex with men (MSM) taking PrEP in Burkina Faso, Côte d'Ivoire, Mali and Togo. METHODS A prospective cohort study among MSM initiating PrEP as part of a comprehensive HIV prevention package was conducted between 2017 and 2021 in community-based clinics in the four study countries. Molecular screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) was performed at months 0, 6 and 12. Serological testing for syphilis was performed every 3 months over the first year of follow-up. Determinants of CT and/or NG incidence were identified using Poisson generalised linear mixed models. RESULTS A total of 598 participants with a median age of 24.7 years were included. Prevalence of CT and/or NG was 24.4% (95% CI 21.0 to 28.1), 22.4% (95% CI 18.4 to 26.8) and 29.0% (95% CI 24.2 to 34.1) at months 0, 6 and 12, respectively. The prevalence of syphilis ranged from 0.2% (95% CI 0.0 to 0.9) at month 0 to 0.8% (95% CI 0.2 to 2.4) at month 12. Ninety incident CT and/or NG infections occurred during a total follow-up time of 280.6 person-years (incidence rate 32.1 per 100 person-years, 95% CI 25.8 to 39.4). Three incident syphilis infections were detected during a total follow-up time of 459.7 person-years (incidence rate 0.7 per 100 person-years, 95% CI 0.1 to 1.9). CT and/or NG incidence was associated with condomless insertive anal sex (adjusted incidence rate ratio 1.96, 95% CI 1.04 to 3.71, p=0.038). CONCLUSIONS CT and NG were frequent but syphilis was very infrequent in MSM using HIV PrEP in West Africa. HIV programme managers should integrate STI services into PrEP programmes.
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Affiliation(s)
- Ter Tiero Elias Dah
- Université de Ouahigouya, Ouahigouya, Burkina Faso
- Association African Solidarité, Ouagadougou, Burkina Faso
| | - Irith De Baetselier
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Benjamin Cuer
- TransVIHMI, University of Montpellier, IRD, Inserm, Montpellier, France
| | | | | | - Amadou Koné
- University of Sciences Technics and Technologies, Bamako, Mali
| | - Souba Diandé
- Laboratoire National de Recherche sur la Tuberculose et les Mycobactéries, Ouagadougou, Burkina Faso
| | | | - Hortense Yaobla Faye-Kette
- Département de Bactériologie-Virologie, Institut Pasteur de Côte d'Ivoire, Abidjan, Côte d'Ivoire
- Laboratoire Central, CHU Yopougon, Abidjan, Côte d'Ivoire
| | - Alain Yeo
- Institut Pasteur Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Issifou Yaya
- TransVIHMI, University of Montpellier, IRD, Inserm, Montpellier, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM Marseille France, Marseille, France
| | | | - Tania Crucitti
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Bea Vuylsteke
- Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Christian Laurent
- TransVIHMI, University of Montpellier, IRD, Inserm, Montpellier, France
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Peters RPH, Nel JS, Sadiq E, Kufa T, Smit DP, Sorour G, Garrett N, Gill K, Makhakhe L, Chandiwana NC, Moran NF, Cohen K, Wattrus C, Moosa MY. Southern African HIV Clinicians Society Guideline for the clinical management of syphilis. South Afr J HIV Med 2024; 25:1577. [PMID: 38725703 PMCID: PMC11079416 DOI: 10.4102/sajhivmed.v25i1.1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/24/2024] [Indexed: 05/12/2024] Open
Abstract
Syphilis, 'the great imitator', caused by Treponema pallidum infection, remains a complex and multifaceted disease with a rich history of clinical diversity. This guideline aims to be a comprehensive guide for healthcare workers in Southern Africa, offering practical insights into the epidemiology, pathogenesis, clinical manifestations, diagnostic testing, therapeutic principles, and public health responses to syphilis. Although the syphilis burden has declined over the years, recent data indicate a troubling resurgence, particularly among pregnant women and neonates. This guideline highlights the diagnostic challenges posed by syphilis, stemming from the absence of a single high-sensitivity and -specificity test. While treatment with penicillin remains the cornerstone of treatment, alternative regimens may be used for specific scenarios. We highlight the importance of thorough patient follow-up and management of sex partners to ensure optimal care of syphilis cases. In the context of public health, we emphasise the need for concerted efforts to combat the increasing burden of syphilis, especially within high-risk populations, including people living with HIV.
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Affiliation(s)
- Remco P H Peters
- Research Unit, Foundation for Professional Development, East London, South Africa
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jeremy S Nel
- Division of Infectious Diseases, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Helen Joseph Hospital, Johannesburg, South Africa
| | - Eitzaz Sadiq
- Helen Joseph Hospital, Johannesburg, South Africa
- Department of Neurosciences, Division of Neurology, University of the Witwatersrand, Johannesburg, South Africa
| | - Tendesayi Kufa
- Centre for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Derrick P Smit
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gillian Sorour
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Lehlohonolo Makhakhe
- Department of Dermatology, University of the Free State, Bloemfontein, South Africa
- The South African Institute of Dermatology, Bloemfontein, South Africa
| | - Nomathemba C Chandiwana
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil F Moran
- KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Karen Cohen
- Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Camilla Wattrus
- Southern African HIV Clinicians Society (SAHCS), Johannesburg, South Africa
| | - Mahomed Yunus Moosa
- Southern African HIV Clinicians Society (SAHCS), Johannesburg, South Africa
- Department of Infectious Disease, Division of Internal Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Mujugira A, Karungi B, Mugisha J, Nakyanzi A, Bagaya M, Kamusiime B, Nalumansi A, Nalukwago GK, Kasiita V, Twesigye CC, Nampewo O, Nsubuga R, Nyanzi KR, Muwonge T, Wyatt MA, Ware NC, Haberer JE. "I felt special!": a qualitative study of peer-delivered HIV self-tests, STI self-sampling kits and PrEP for transgender women in Uganda. J Int AIDS Soc 2023; 26:e26201. [PMID: 38147031 PMCID: PMC10750840 DOI: 10.1002/jia2.26201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/05/2023] [Indexed: 12/27/2023] Open
Abstract
INTRODUCTION Peer delivery is a client-centred approach that could maximize the coverage and impact of HIV services for transgender women (TGW). We conducted qualitative interviews to examine how peer-delivered HIV self-testing (HIVST), sexually transmitted infection self-sampling (STISS) and oral pre-exposure prophylaxis (PrEP) influenced prevention choices among TGW and their intimate partners in Uganda. METHODS Within a cluster randomized trial of peer-delivered HIVST, STISS and PrEP among HIV-negative TGW (NCT04328025), we conducted 55 qualitative interviews with 30 TGW, 15 intimate partners and 10 TGW peers (August 2021-February 2022). TGW interviews explored: (1) HIV self-test and PrEP experiences; (2) HIVST with intimate partners; and (3) descriptions of self-sampling for STI testing. Partner interviews covered: (1) experiences with HIVST; (2) disclosure of HIV status to intimate partner; and (3) descriptions of sexual behaviours after testing. Peer interview topics included: (1) intervention delivery experiences; and (2) recommendations for peer-delivered HIV prevention services to TGW, including psychological support and coping strategies. Qualitative data were analysed using an inductive content analytic approach. RESULTS Peer-delivered combination prevention was valued by this group of TGW and their partners. (1) Peer services extended beyond delivering HIV/STI kits and PrEP refills to caring for individual health and wellbeing by providing stigma coping strategies. Peer psychosocial support empowered research participants to become "HIVST ambassadors," teach non-study TGW about self-testing and PrEP, and encourage linkage to care. (2) HIVST with intimate partners and mutual disclosure of HIV status strengthened partnered relationships. PrEP use after both partners tested HIV negative implied infidelity. (3) Self-sampling enabled TGW to take control of their STI testing and avoid the embarrassment of exposing their bodies. Privacy and confidentiality motivated the uptake of STI testing and treatment. CONCLUSIONS In this sample of TGW from Uganda, peer delivery of HIVST, STISS and PrEP refills benefitted individual prevention efforts and extended to a new linkage of TGW not engaged in care. Integrating peer services into differentiated PrEP delivery could increase HIV/STI test coverage and PrEP use in this vulnerable population.
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Affiliation(s)
- Andrew Mujugira
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | | | - Jackson Mugisha
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | - Agnes Nakyanzi
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | - Monica Bagaya
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | - Brenda Kamusiime
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | - Alisaati Nalumansi
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | | | - Vicent Kasiita
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | | | - Olivia Nampewo
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | - Rogers Nsubuga
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | | | - Timothy Muwonge
- The Infectious Diseases Institute LimitedMakerere UniversityKampalaUganda
| | - Monique A. Wyatt
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Harvard GlobalCambridgeMassachusettsUSA
| | - Norma C. Ware
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Department of MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Jessica E. Haberer
- Center for Global HealthMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
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Malefo MA, Ayo-Yusuf O, Mokgatle MM. Risk factors for sexually transmitted infections among men who have sex with men. Afr J Prim Health Care Fam Med 2023; 15:e1-e7. [PMID: 37916720 PMCID: PMC10623483 DOI: 10.4102/phcfm.v15i1.4080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) are a global public health concern and sub-Saharan Africa, has limited data on STIs in the men who have sex with men (MSM) population. Syndromic management has controversies for treating asymptomatic STIs (ASTIs). AIM The aim of this study was to describe the risk factors for STIs among MSM. SETTING This study was conducted in Tshwane North, Gauteng Province in South Africa. METHODS A cross-sectional quantitative design was employed using structured questionnaires, rapid plasma reagent test, from December 2021 to May 2022. Bivariate and multivariate analyses were used for statistical analysis. RESULTS A total of 200 MSM with the mean age of 27.6, standard deviations: 6.8 participated, and STIs prevalence was 66%, with 37% concurrent infections. Ureaplasma urealyticum was (24%), Mycoplasma hominis (23%), Chlamydia trachomatis (20%), Treponema pallidum (20%) and Neisseria gonorrhoeae (9%). The risk factors for acquisition of STI include having a new partner in the last month (OR = 1.68; CI: 0.98-3.13). CONCLUSION The prevalence of ASTIs is high. Serial and multiple sexual partners are the risk factors.Contribution: This study contributes to the body of knowledge of the burden of STIs among high-risk population.
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Affiliation(s)
- Matshidiso A Malefo
- School of Health Care Sciences, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria.
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Peters RPH, McIntyre JA, Garrett N, Brink AJ, Celum CL, Bekker LG. Doxycycline post-exposure prophylaxis for sexually transmitted infections in South Africa. South Afr J HIV Med 2023; 24:1510. [PMID: 37795430 PMCID: PMC10546896 DOI: 10.4102/sajhivmed.v24i1.1510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/20/2023] [Indexed: 10/06/2023] Open
Abstract
South Africa has a large burden of bacterial sexually transmitted infections (STIs) with high rates among men who have sex with men (MSM). Randomised controlled trials have recently demonstrated high effectiveness of doxycycline post-exposure prophylaxis (PEP) for prevention of bacterial STIs in MSM, with 70% - 85% reductions in Chlamydia trachomatis infection and syphilis, and approximately 50% reduction in Neisseria gonorrhoeae infection. Doxycycline PEP was not demonstrated to be effective in reducing C. trachomatis and N. gonorrhoeae infection among Kenyan cisgender women. Although no worrisome trends in antimicrobial resistance (AMR) were observed in the trials, important concerns remain about doxycycline PEP and AMR development in STIs, other pathogens, commensals, and the microbiome. Tetracycline resistance in N. gonorrhoeae is already widespread in South Africa, but emergence of AMR in other STIs would be concerning. Larger sample sizes of doxycycline PEP users with longer follow-up time are needed to understand the impact that doxycycline PEP may have on AMR at individual and population level. In this opinion article, we weigh the benefits of doxycycline PEP for prevention of bacterial STIs against the existing AMR concerns and data gaps in the South African context. Based on the current evidence, we conclude that it would be reasonable to offer doxycycline PEP to high-risk MSM on a case-by-case basis, provided that it is offered by experienced sexual health clinicians in settings that have access to diagnostic STI testing and ongoing AMR surveillance.
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Affiliation(s)
- Remco P H Peters
- Research Unit, Foundation for Professional Development, East London, South Africa
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - James A McIntyre
- Anova Health Institute, Johannesburg, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Adrian J Brink
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Connie L Celum
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, United States of America
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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Anand P, Wu L, Mugwanya K. Integration of sexually transmitted infection and HIV pre-exposure prophylaxis services in sub-Saharan Africa: a scoping review. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:944372. [PMID: 37457431 PMCID: PMC10338918 DOI: 10.3389/frph.2023.944372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/31/2023] [Indexed: 07/18/2023] Open
Abstract
Background Persons living in sub-Saharan Africa (SSA) face disproportionate risk from overlapping epidemics of HIV and bacterial sexually transmitted infections (STIs). Pre-exposure prophylaxis (PrEP) for prevention is gradually being scaled up globally including in several settings in SSA, which represents a key opportunity to integrate STI services with HIV pre-exposure prophylaxis (PrEP). However, there is limited literature on how to successfully integrate these services, particularly in the SSA context. Prior studies and reviews on STI and PrEP services have largely focused on high income countries. Methods We conducted a scoping review of prior studies of integration of STI and PrEP services in SSA. We searched PubMed, EMBASE, Cochrane, and CINAHL, in addition to grey literature to identify studies that were published between January 2012 and December 2022, and which provided STI and PrEP services in SSA, with or without outcomes reported. Citations and abstracts were reviewed by two reviewers for inclusion. Full texts were then retrieved and reviewed in full by two reviewers. Results Our search strategy yielded 1951 records, of which 250 were retrieved in full. Our final review included 61 reports of 45 studies. Most studies were conducted in Southern (49.2%) and Eastern (24.6%) Africa. Service settings included public health clinics (26.2%), study clinics (23.0%), sexual and reproductive care settings (23.0%), maternal and child health settings (8.2%), community based services (11.5%), and mobile clinics (3.3%). A minority (11.4%) of the studies described only syndromic STI management while most (88.6%) included some form of etiological laboratory STI diagnosis. STI testing frequency ranged from baseline testing only to monthly screening. Types of STI tested for was also variable. Few studies reported outcomes related to implementation of STI services. There were high rates of curable STIs detected by laboratory testing (baseline genitourinary STI rates ranged from 5.6-30.8% for CT, 0.0-11.2% for GC, and 0.4-8.0% for TV). Discussion Existing studies have implemented a varied range of STI services along with PrEP. This range reflects the lack of specific guidance regarding STI services within PrEP programs. However, there was limited evidence regarding implementation strategies for integration of STI and PrEP services in real world settings.
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Affiliation(s)
- Priyanka Anand
- Department of Medicine, University of Washington School of Medicine, Seattle, WAUnited States
| | - Linxuan Wu
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Kenneth Mugwanya
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
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Mashingaidze R, Moodie Z, Allen M, Bekker LG, Grove D, Grunenberg N, Huang Y, Janes HE, Lazarus EM, Malahleha M, Nchabeleng M, Laher F. Sexually transmitted infections amongst men who have sex with men (MSM) in South Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001782. [PMID: 37018240 PMCID: PMC10075439 DOI: 10.1371/journal.pgph.0001782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 03/07/2023] [Indexed: 04/06/2023]
Abstract
There is limited data about bacterial STIs in MSM populations in sub-Saharan Africa. Our retrospective analysis used data from the HVTN 702 HIV vaccine clinical trial (October 2016 to July 2021). We evaluated multiple variables. Polymerase chain reaction testing was conducted on urine and rectal samples to detect Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) every 6 months. Syphilis serology was conducted at month 0 and thereafter every 12 months. We calculated STI prevalence and the associated 95% confidence intervals until 24 months of follow-up. The trial enrolled 183 participants who identified as male or transgender female, and of homosexual or bisexual orientation. Of these, 173 had STI testing done at month 0, median age was 23 (IQR 20-25) years, with median 20.5 (IQR 17.5-24.8) months follow-up (FU). The clinical trial also enrolled and performed month 0 STI testing on 3389 female participants, median age 23 (IQR 21-27) years, median 24.8 (IQR 18.8-24.8) months FU and 1080 non-MSM males with a median age of 27 (IQR 24-31) years, median 24.8 (IQR 23-24.8) months FU. At month 0, CT prevalence was similar in MSM and females (26.0% vs 23.0%, p = 0.492) but was more prevalent in MSM compared to non-MSM males (26.0% vs 14.3%, p = 0.001). CT was the most prevalent STI among MSM at months 0 and 6 but declined from month 0 to month 6 (26.0% vs 17.1%, p = 0.023). In contrast, NG did not decline in MSM between months 0 and 6 (8.1% vs 7.1%, p = 0.680) nor did syphilis prevalence between months 0 and 12 (5.2% vs 3.8%, p = 0.588). Bacterial STI burden is higher in MSM compared to non-MSM males, and CT is the most prevalent bacterial STI amongst MSM. Preventive STI vaccines, especially against CT, may be helpful to develop.
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Affiliation(s)
- Rujeko Mashingaidze
- Faculty of Health Sciences, Perinatal HIV Research Unit, University of the Witwatersrand, Diepkloof, Soweto, South Africa
| | - Zoe Moodie
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Mary Allen
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Vaccine Research Program, Bethesda, Maryland, United States of America
| | - Linda-Gail Bekker
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - Doug Grove
- Fred Hutchinson Cancer Center (SCHARP, HVTN), Seattle, WA, United States of America
| | - Nicole Grunenberg
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Yunda Huang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Holly E. Janes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Erica Maxine Lazarus
- Faculty of Health Sciences, Perinatal HIV Research Unit, University of the Witwatersrand, Diepkloof, Soweto, South Africa
| | | | | | - Fatima Laher
- Faculty of Health Sciences, Perinatal HIV Research Unit, University of the Witwatersrand, Diepkloof, Soweto, South Africa
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Kim CM, Zhao V, Brito De Mello M, Baggaley R, Johnson CC, Spielman E, Fairley CK, Zhang L, de Vries H, Klausner J, Zhao R, Ong JJ. Determining the screening frequency for sexually transmitted infections for people who use HIV pre-exposure prophylaxis: a systematic review and meta-analysis. Int J Infect Dis 2023; 129:181-187. [PMID: 36690140 DOI: 10.1016/j.ijid.2023.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Although the World Health Organization recommends 'frequent' screening of sexually transmitted infections (STI) for people who use pre-exposure prophylaxis for HIV, there is no evidence for optimal frequency. METHODS We searched five databases and used random-effects meta-analysis to calculate pooled estimates of STI test positivity. We narratively synthesized data on secondary outcomes, including adherence to recommended STI screening frequency and changes in STI epidemiology. RESULTS Of 7477 studies, we included 38 for the meta-analysis and 11 for secondary outcomes. With 2-3 monthly STI screening, the pooled positivity was 0.20 (95% confidence interval [CI]: 0.15-0.25) for chlamydia, 0.17 (95% CI: 0.12-0.22) for gonorrhea, and 0.07 (95% CI: 0.05-0.08) for syphilis. For chlamydia and gonorrhea, the positivity was approximately 50% and 75% lower, respectively, in studies that screened 4-6 monthly vs 2-3 monthly. There was no significant difference in the positivity for syphilis in studies that screened 4-6 monthly compared to 2-3 monthly. Adherence of clients to recommended screening frequency varied significantly (39-94%) depending on population and country. Modeling studies suggest more frequent STI screening could reduce incidence. CONCLUSION Although more frequent STI screening could reduce delayed diagnoses and incidence, there remain significant knowledge gaps regarding the optimal STI screening frequency.
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Affiliation(s)
- Cham-Mill Kim
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Victor Zhao
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Maeve Brito De Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl C Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Erica Spielman
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Lei Zhang
- Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Henry de Vries
- Amsterdam UMC location University of Amsterdam, Department of Dermatology, Amsterdam, The Netherlands; Amsterdam Institute for Infection and Immunology, Infectious Diseases, Amsterdam, The Netherlands; Center for Sexual Health, Department of Infectious Diseases, Public Health Service Amsterdam, The Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Jeffrey Klausner
- Keck School of Medicine of University of Southern California, Los Angeles, United States
| | - Rui Zhao
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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10
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Larmarange J, Broqua C. Les hommes bisexuels sont moins exposés au virus de l’immunodéficience humaine que les homosexuels exclusifs en Afrique subsaharienne. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 34:123-132. [PMID: 37336726 DOI: 10.3917/spub.hs2.0123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
INTRODUCTION In sub-Saharan Africa, as in the rest of the world, men who have sex with men (MSM) are at greater risk of HIV infection than the general population. Bisexuals are often perceived to be more at risk than exclusive gay men. PURPOSE OF RESEARCH We propose a review of epidemiological surveys conducted in sub-Saharan Africa since 2005 to provide an overview of knowledge on HIV exposure among gay/bisexual men. RESULTS We reviewed 355 publications and identified 62 measures of the association between bisexuality and HIV prevalence and 8 measures of the association between bisexuality and incidence. Except for 4 of 62 measures, the HIV prevalence observed among bisexuals was equal to or lower than that observed among exclusive gay men. In terms of incidence, all but one of the identified studies observed lower or equal HIV incidence among bisexuals. From a behavioural perspective, most studies found no difference in condom use. Bisexuals may have less frequent sex and consistently less receptive anal sex. They mainly started their sexual lives with men later, had fewer partners, and were less likely to know their HIV status. CONCLUSIONS Bisexuals are less likely to be at risk of HIV than exclusive gay men, partly because of behavioural differences. Prevention and treatment programs for MSM must take the specificities of bisexuals into account and design differentiated services.
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11
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Tun W, Pulerwitz J, Shoyemi E, Fernandez A, Adeniran A, Ejiogu F, Sangowawa O, Granger K, Dirisu O, Adedimeji AA. A qualitative study of how stigma influences HIV services for transgender men and women in Nigeria. J Int AIDS Soc 2022; 25 Suppl 1:e25933. [PMID: 35818868 PMCID: PMC9274359 DOI: 10.1002/jia2.25933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/05/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Transgender men and women in Nigeria experience many barriers in accessing HIV prevention and treatment services, particularly given the environment of transphobia (including harassment, violence and discrimination) and punitive laws in the country. HIV epidemic control in Nigeria requires improving access to and quality of HIV services for key populations at high risk, including transgender men and women. We assessed how stigma influences HIV services for transgender people in Lagos, Nigeria. METHODS In-depth interviews (IDIs) and focus group discussions were conducted with transgender men (n = 13) and transgender women (n = 25); IDIs were conducted with community service organization (CSO) staff (n = 8) and healthcare providers from CSO clinics and public health facilities (n = 10) working with the transgender population in March 2021 in Lagos. Content analysis was used to identify how stigma influences transgender people's experiences with HIV services. RESULTS AND DISCUSSION Three main findings emerged. First, gender identity disclosure is challenging due to anticipated stigma experienced by transgender persons and fear of legal repercussions. Fear of being turned in to authorities was a major barrier to disclose to providers in facilities not affiliated with a transgender-inclusive clinic. Providers also reported difficulty in eliciting information about the client's gender identity. Second, respondents reported lack of sensitivity among providers about gender identity and conflation of transgender men with lesbian women and transgender women with being gay or men who have sex with men, the latter being more of a common occurrence. Transgender participants also reported feeling disrespected when providers were not sensitive to their pronoun of preference. Third, HIV services that are not transgender-inclusive and gender-affirming can reinforce stigma. Both transgender men and women spoke about experiencing stigma and being refused HIV services, especially in mainstream public health facilities, as opposed to transgender-inclusive CSO clinics. CONCLUSIONS This study highlights how stigma impedes access to appropriate HIV services for transgender men and women, which can have a negative impact along the HIV care continuum. There is a need for transgender-inclusive HIV services and competency trainings for healthcare providers so that transgender clients can receive appropriate and gender-affirming HIV services.
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Affiliation(s)
- Waimar Tun
- Social and Behavioral Science Research, Population Council, Washington, DC, USA
| | - Julie Pulerwitz
- Social and Behavioral Science Research, Population Council, Washington, DC, USA
| | | | | | | | | | | | - Krista Granger
- Social and Behavioral Science Research, Population Council, Washington, DC, USA
| | - Osasuyi Dirisu
- Policy Innovation Unit, Nigerian Economic Summit Group, Lagos, Nigeria
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12
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Crowell TA, Nitayaphan S, Sirisopana N, Wansom T, Kitsiripornchai S, Francisco L, Li Q, Dear N, O'Connell RJ, Pitisuttithum P, Vasan S. Factors associated with testing for HIV and other sexually transmitted infections in men who have sex with men and transgender women in Bangkok, Thailand. AIDS Res Ther 2022; 19:25. [PMID: 35729561 PMCID: PMC9210729 DOI: 10.1186/s12981-022-00449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Routine screening for HIV and other sexually transmitted infections (STIs) facilitates early diagnosis and treatment, thereby preventing morbidity and onward transmission. We estimated the prevalence of prior HIV/STI testing among men who have sex with men (MSM) and transgender women (TGW) in Bangkok, Thailand, and identified factors associated with prior testing. Methods Cross-sectional analyses were performed using data collected at enrollment into an HIV incidence cohort. From April to October 2017, MSM and TGW were enrolled if they were aged 18–35 years, reported anal intercourse with a male or TGW partner, and reported behavioral vulnerability to HIV. Participants answered questions about demographics, sexual behaviors, and lifetime HIV/STI testing history. Multivariable robust Poisson regression was used to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for factors potentially associated with prior testing. Results Among 1,014 participants, 348 (34.3%) were TGW and the median age was 21.6 (interquartile range 20.0-24.8) years. Prior testing for HIV was reported by 421 (41.5%) and for other STIs by 268 (26.4%). HIV testing was more common among participants aged ≥ 22 years (RR 1.37 [95% CI 1.13–1.67]), with college education as compared to secondary or less (RR 1.37 [95% CI 1.08–1.72]), and who met male sexual partners online (RR 1.52 [95% CI 1.24–1.85]), but lower among participants attracted to both men and women as compared to men only (RR 0.64 [95% CI 0.51–0.81]) and who met male sexual partners in bars (RR 0.83 [95% CI 0.72–0.97]). Similar associations were observed with prior testing for other STIs, including increased testing among participants with college education (RR 1.52 [95% CI 1.11–2.09]) and who met male sexual partners online (RR 1.73 [95% CI 1.30–2.31]), but lower among participants attracted to both men and women (RR 0.70 [95% CI 0.51–0.96]) and who met male sexual partners in bars (RR 0.67 [95% CI 0.54–0.83]). Conclusions Despite behavioral vulnerability, prior testing for HIV and other STIs was uncommon. Online engagement strategies may be effectively reaching Thai MSM and TGW who meet sexual partners online, but new interventions are needed to encourage testing among younger, less educated, and bisexual MSM and TGW.
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Affiliation(s)
- Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA. .,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
| | | | | | - Tanyaporn Wansom
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.,Dreamlopments Social Enterprise and Foundation, Bangkok, Thailand
| | | | - Leilani Francisco
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Qun Li
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Nicole Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Robert J O'Connell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | - Sandhya Vasan
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
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13
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Dzobo M, Dzinamarira T, Murewanhema G, Madziva R, Herrera H, Musuka G. Limited syphilis testing for key populations in Zimbabwe: A silent public health threat. S Afr J Infect Dis 2022; 37:385. [PMID: 35815225 PMCID: PMC9257705 DOI: 10.4102/sajid.v37i1.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/31/2022] [Indexed: 11/01/2022] Open
Abstract
In this article, the authors discuss the problem of high prevalences of active syphilis amongst key populations (KPs) in Zimbabwe, in combination with low testing rates, partly because of a difficult legal and social environment for these populations. The article highlights the need to develop strategies to address the high prevalence of syphilis amongst KPs. The authors discuss requirements for addressing deficits in existing clinical services, predominantly primary care settings, in providing primary healthcare, including sexually transmitted infection (STI) management, to Zimbabwe’s KP communities and utility of point-of-care testing and self-testing and other innovations to improve testing uptake.
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Affiliation(s)
- Mathias Dzobo
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Tafadzwa Dzinamarira
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Grant Murewanhema
- Unit of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Roda Madziva
- School of Sociology and Social Policy, University of Nottingham, Nottingham, United Kingdom
| | - Helena Herrera
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
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14
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Dadzie LK, Agbaglo E, Okyere J, Aboagye RG, Arthur-Holmes F, Seidu AA, Ahinkorah BO. OUP accepted manuscript. Int Health 2022; 14:545-553. [PMID: 35134172 PMCID: PMC9623488 DOI: 10.1093/inthealth/ihab088] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/17/2021] [Accepted: 01/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background Sexually transmitted infections (STIs) affect individuals of all ages, but adolescent girls and young women are disproportionately affected. We examined the prevalence and factors associated with self-reported STIs (SR-STIs) among adolescent girls and young women in sub-Saharan Africa (SSA). Methods Demographic and Health Survey data of 27 sub-Saharan African countries were used for the study. The sample size comprised 68944 adolescent girls and young women
(15–24 y of age). The outcome variable was SR-STIs. Multilevel binary logistic regression analysis was performed to identify factors associated with SR-STIs. Results On average, the prevalence of SR-STIs among adolescent girls and young women in SSA was 6.92%. The likelihood of SR-STIs was higher among young women aged 20–24 y (adjusted odds ratio [aOR] 1.36 [confidence interval {CI} 1.27 to 1.46]), those not married (aOR 1.64 [CI 1.51 to 1.79]), those working (aOR 1.20 [CI 1.12 to 1.27]), those whose age at first sex was ≤19 y (aOR 1.99 [CI 1.80 to 2.20]), those with two or more sex partners (aOR 1.56 [CI 1.35 to 1.80]), those who listened to radio (aOR 1.26 [CI 1.17 to 1.35]), those in urban areas (aOR 1.42 [CI 1.30 to 1.51]) and those with a wealth index of rich (aOR 1.28 [CI 1.17 to 1.40]) compared with their counterparts. In contrast, those with a primary (aOR 0.86 [CI 0.78 to 0.94]) or secondary/higher level of education (aOR 0.83 [CI 0.75 to 0.92]) compared with those with no formal education and those who were exposed to television (aOR 0.90 [CI 0.84 to 0.98]) compared with those who were not exposed were less likely to report STIs. Conclusions Our findings demonstrate the need for countries in SSA to commit towards reducing the incidence of STIs. Community-based health educational programs are required to intensify the awareness of STIs and their prevention in various sub-Saharan African countries considering the factors that expose adolescent girls and young women to STIs.
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Affiliation(s)
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Francis Arthur-Holmes
- Department of Sociology and Social Policy, Lingnan University, 8 Castle Peak Road, Tuen Mun, Hong Kong
| | - Abdul-Aziz Seidu
- Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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15
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Hiransuthikul A, Janamnuaysook R, Himma L, Taya C, Amatsombat T, Chumnanwet P, Samitpol K, Chancham A, Kongkapan J, Rueannak J, Getwongsa P, Srimanus P, Teeratakulpisarn N, Thammajaruk N, Avery M, Wansom T, Mills S, Ramautarsing RA, Phanuphak N. Acceptability and satisfaction towards self-collection for chlamydia and gonorrhoea testing among transgender women in Tangerine Clinic, Thailand: shifting towards the new normal. J Int AIDS Soc 2021; 24:e25801. [PMID: 34496152 PMCID: PMC8425782 DOI: 10.1002/jia2.25801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Provider‐collected swabs are an unappealing procedure for many transgender women and may have led to suboptimal rates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing. Self‐collection for CT/NG testing is recommended for men who have sex with men. However, the information on acceptability and clinical performance to support a recommendation for transgender women is lacking. We aimed to determine the acceptability and satisfaction towards self‐collection for CT/NG testing among Thai transgender women. Methods Thai transgender women who attended Tangerine Clinic (a transgender‐led, integrated, gender‐affirming care and sexual health services clinic in Bangkok, Thailand) between May and July 2020 and had condomless sexual intercourse within the past six months were offered to collect urine and perform self‐swabs of pharyngeal, rectal, and if applicable, neovaginal compartments for pooled nucleic acid amplification testing for CT/NG infections. Participants received a diagram, video and oral instructions about how to perform self‐collection procedure. Those who accepted self‐collection were also offered to receive provider collection to evaluate the performance between the two methods. Self‐administered questionnaires were used to assess satisfaction. Results Among 216 transgender women enrolled, 142 (65.7%) accepted self‐collection. All who accepted had pharyngeal, rectal and urine samples collected. Of 31 transgender women who had undergone genital surgery, 28 (90.3%) accepted neovaginal self‐swab. The acceptance rate increased from 46.2% in May to 84.5% in July 2020. One participant had an invalid result. All transgender women who accepted self‐collection could perform it without assistance, and 82.8% were highly satisfied with the method. None reported dissatisfaction. Due to the COVID‐19 pandemic, provider collection services were discontinued early, and only eight transgender women were able to perform both methods for performance evaluation. The performance agreement was 100%. Conclusions Thai transgender women had high acceptability and satisfaction towards self‐collection for CT/NG testing. The performance was promising compared to provider collection. Our results support the implementation of self‐collection to the sexually transmitted infection services, particularly during the COVID‐19 pandemic where physical distancing is the new normal. A larger study is warranted to determine the performance of self‐collection for CT/NG testing in each anatomical compartment and confirm the performance between self‐collection and provider collection.
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Affiliation(s)
- Akarin Hiransuthikul
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand.,Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rena Janamnuaysook
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand.,Centre of Excellence in Transgend Health (CETH), Chulalongkorn University, Bangkok, Thailand
| | - Linrada Himma
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand.,Centre of Excellence in Transgend Health (CETH), Chulalongkorn University, Bangkok, Thailand
| | - Chiraporn Taya
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand
| | | | | | - Kritima Samitpol
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand
| | | | | | | | | | - Peevara Srimanus
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand
| | | | | | | | | | | | | | - Nittaya Phanuphak
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand.,Centre of Excellence in Transgend Health (CETH), Chulalongkorn University, Bangkok, Thailand
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16
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Yaya I, Diallo F, Kouamé MJB, Agboyibor MK, Traoré I, Coulibaly A, Maiga K, Mora M, Palvadeau P, Dah ETT, Mensah E, Anoma C, Dembélé Keita B, Spire B, Laurent C. Decrease in incidence of sexually transmitted infections symptoms in men who have sex with men enrolled in a quarterly HIV prevention and care programme in West Africa (CohMSM ANRS 12324-Expertise France). Sex Transm Infect 2021; 98:85-94. [PMID: 33753460 DOI: 10.1136/sextrans-2020-054755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/19/2021] [Accepted: 01/30/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Although men who have sex with men (MSM) are at high risk of STI, their access to tailored healthcare services remains limited in West Africa. We assessed the change in STI symptoms incidence over time among MSM enrolled in a quarterly HIV prevention and care programme in four cities in Burkina Faso, Côte d'Ivoire, Mali and Togo. METHODS We performed a prospective cohort study in MSM followed up between 2015 and 2019. Men aged over 18 who reported anal sex with another man within the previous 3 months were offered quarterly syndromic diagnosis and treatment for STI, as well as HIV testing, peer-led counselling and support. Condoms and lubricants were also provided. The change in STI symptoms incidence during follow-up was investigated using a non-parametric trend test and mixed-effect Poisson regression models. RESULTS 816 participants were followed for a total duration of 1479 person-years. 198 participants (24.3%) had at least one STI symptom during follow-up. Overall, STI symptoms incidence was 20.4 per 100 person-years (95% CI 18.4 to 22.6), ranging from 15.3 in Abidjan to 33.1 in Ouagadougou (adjusted incidence rate ratio (aIRR) 2.39, 95% CI 1.55 to 3.69, p<0.001). STI symptoms incidence was 16.8 and 23.0 per 100 person-years in HIV-positive and HIV-negative participants, respectively (aIRR 0.77, 95% CI 0.57 to 1.04, p=0.087). STI symptoms incidence decreased significantly from 29.9 per 100 person-years in the first 6 months to 8.6 at 30-35 months of follow-up (aIRR per 6-month increase 0.84, 95% CI 0.77 to 0.92, p<0.001). CONCLUSION STI symptoms incidence decreased over time but the overall burden of STI appeared to be very high in MSM followed up in West Africa. STI services including counselling, diagnosis and treatment should be reinforced. Laboratory tests that allow accurate diagnosis of STI are required. Strengthening STI services will be critical for controlling the HIV and STI epidemics in this vulnerable population and in the general population. TRIAL REGISTRATION NUMBER NCT02626286.
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Affiliation(s)
- Issifou Yaya
- IRD, Inserm, Univ Montpellier, TransVIHMI, Montpellier, France
| | | | | | | | - Issa Traoré
- Association African Solidarité, Ouagadougou, Burkina Faso
| | | | | | - Marion Mora
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Marseille, France
| | | | - Elias Ter Tiero Dah
- IRD, Inserm, Univ Montpellier, TransVIHMI, Montpellier, France.,Association African Solidarité, Ouagadougou, Burkina Faso.,Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | | | | | - Bruno Spire
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Marseille, France
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