Page 383 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 2 of 6 Original Research

The prevalence of STIs varies according to region, gender A 4 mL blood sample was collected into a clot activating
and risk group. A number of key populations with high tube and processed for onsite testing. Processing involved
prevalence of STIs have been reported. These include sex centrifuging of the sample after clotting and harvesting the
workers, their clients and other partners; men who have sex serum for subsequent tests. Herpes simplex virus type 2
with men; transgender people; people who inject drugs; and infection was tested in serum using PreCheck HSV 2 IgG test
people living with HIV (PLWH). Enhanced STI screening is kits. The seroprevalence of syphilis was defined as having a
recommended in these key populations. 9,10,11 However, positive treponemal-specific antibody test using the SD
access and uptake of STI services among these groups is Bioline Rapid Antibody Test with or without a positive non-
often challenging. In resource-limited settings, there are treponemal RPR carbon assay. All participants with confirmed
limited data regarding the prevalence of STIs, with the STI diagnoses were managed using an aetiological approach,
exception of HIV, which is often the only STI for which and respective antibiotic treatment was administered as
functioning surveillance systems are in place. In Zimbabwe, recommended in the national guidelines. 14
the prevalence of HIV among adults aged 15–64 years is
12
14.6%, corresponding to approximately 1.2 million PLWH. VL measurements were performed on EDTA plasma using
Coinfection rates of HIV and STIs are not widely reported the Roche COBAS Ampliprep and TaqMan version 2.0, while
and there are no local guidelines regarding the screening CD4+ counts were measured in whole blood using a Partec
for STIs in PLWH. This study was conducted to determine Cyflow Counter II.
the prevalence of STI coinfection in a cohort of HIV-infected
women and to identify associated risk factors for an STI
diagnosis. Statistical analysis
Data were entered into a Microsoft Access 2016 database and
Methods then exported to Microsoft Excel for cleaning. Cleaned data
were exported to Stata 12.1 for analysis. Medians and
This analytic cross-sectional study was conducted in HIV-
infected adult women at Newlands Clinic (NC), Harare, interquartile ranges (IQR) were used to describe continuous
Zimbabwe. NC provides comprehensive HIV care and data. A maximum p-value of 0.05 was considered statistically
treatment services to approximately 6000 individuals in the significant. Unadjusted odds ratios with 95.0% confidence
greater Harare urban area. The clinic operates in a public- intervals (CIs) were calculated for risk factors of STIs.
private partnership with the Ministry of Health and Child Significant risk factors in univariate analysis were further
Care, Zimbabwe. Funding for the clinic is provided by the analysed in a multivariable logistic regression to calculate
13
Ruedi Luethy Foundation and other partners. Sexually adjusted odds ratios.
active, non-pregnant adult women (≥ 18 years of age)
attending NC for routine annual cervical screening were Ethical consideration
invited to participate in the study. The study was approved by the NC Research Unit and the
Medical Research Council of Zimbabwe (approval number
Study procedures MRCZ/A/1980). All participants provided written informed
consent before enrolling in the study.
A questionnaire was verbally administered by a trained
study nurse, which collected sociodemographic, medical, Results
gynaecological and sexual history data. Current CD4+ count,
HIV VL and antiretroviral therapy (ART) history were Participant enrolment
documented in the medical history. Current CD4+ count and Between 01 January and 30 June 2016, 385 women were
VL were defined as results which had been obtained within enrolled in the study, 356 (93.0%) being on ART. The median
the preceding month. The sexual history included questions age of the participants was 41 years (IQR: 35–47). A total of
regarding age of sexual debut, number of sexual partners, 171 (44.0%) participants were married and 103 (27.0%) were
type of sexual activity, STI symptoms, previous STI diagnoses, widows; 86 (22.0%) had seven years or less of education and
condom use, family planning, sexual orientation and past 57 (15.0%) had reached tertiary education. Table 1 shows the
history of sexual abuse. characteristics of the participants in the study.

On completion of the questionnaire, a complete abdominal
and gynaecological examination including the collection of HIV treatment history
endocervical swabs was conducted. Findings were recorded Of the 356 (93.0%) participants who were taking ART, 324
on a participant’s respective case report forms. On completion (91.0%) were virologically suppressed with VLs of < 50 copies/
of endocervical swab collection, the nurse proceeded with an mL. Twelve (3.0%) were severely immunocompromised
examination of the cervix using the visual inspection with (CD4+ cell count < 100 cells/mL), but the majority were
acetic acid and cervicography (VIAC) methodology. The immunocompetent with the median CD4+ cell count being 503
swabs were used for Chlamydia trachomatis (CT), Neisseria (IQR: 347–655) cells/μL. Among those receiving ART, the
gonorrhoeae (NG), and Trichomonas vaginalis (TV) using the median duration on ART was 6.2 years (IQR: 3.2–9.0) and 323
Cepheid Xpert® CT/NG and Xpert® TV assays. women (84.0%) were taking a first-line ART regimen.

http://www.sajhivmed.org.za 376 Open Access