11th International AIDS Conference Vancouver, British Columbia — July 7-12, 1996

Int Conf AIDS 1996 Jul 7-12; 11:34 (abstract no. LB.C. 6062)
Mwijarubi E, Grosskurth H, Mosha F, Mayaud P, Mugeye K, Todd J, Cornelissen J, West B, Gavyole A, Hayes R, Mabey; Tropical Health Epidemiology Unit, London School of Hygiene & Tropical Medicine, London, England. Fax: 44-171-436-4230. E-mail: ethehgro@lshtm.ac.uk.

OBJECTIVE: To measure the impact of improved STD management, using the syndromic approach at the primary health care level, on STD prevalences in Mwanza Region, Tanzania. The impact on HIV incidence (a 42% reduction) has been reported previously, but only preliminary data on STD impact have been published.

METHODS: Community-randomized trial in which STD prevalences were measured in six communities with improved STD treatment services, and six matched comparison communities. A random cohort of approximately 12,000 adults aged 15-54 years was surveyed for STDs at baseline and after two years. Sera were collected to TPHA and RPR serology. Urethral swabs were taken from men who were symptomatic or positive by leukocyte esterase urine dipstick, and tested by gram stain. Urethritis was defined as greater than or equal to 5 polymorphs per high power field. STD prevalences were also recorded among antenatal clinic (ANC) attendees in two consecutive cross-sectional surveys of 1,200 women. Odds ratios (OR) were computed allowing for the community-randomized design and adjusting for baseline STD prevalence and other confounders.

RESULTS: At follow-up, the prevalence of active syphilis (TPHA+/RPR greater than or equal to 1:8) was significantly lower in the intervention (1:5.0%) than the comparison (C:7.0%) communities (OR=0.71, p=0.02). Efficacy increased with the RPR titer (for RPR greater than or equal to 1:32:OR=0.58, p=0.02). TPHA seroincidence also showed a non-significant reduction (OR=0.69, p=0.23). There was no significant reduction in the overall prevalence of urethritis (OR=0.86, p=0.51), but symptomatic urethritis was considerably reduced (1:1.8%, C:3.2%; OR=0.51, p=0.06). No reduction was observed in any STD in ANC attendees.

CONCLUSION: Improved STD treatment services led to steep reductions in the prevalence of syphilis and symptomatic urethritis, and this helps to explain the substantial impact on HIV incidence. Such services should form an essential component of AIDS control programs. There was little effect on asymptomatic STDs, which are highly prevalent in this population, and more intensive control measures may be needed to address this important health problem.

960707
LBC6062

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