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Sexually Transmitted Infections Among HIV-Infected Adults in HIV Care Programs in Kenya: A National Sample of HIV Clinics

Singa, Benson MBChB, MPH*; Glick, Sara Nelson PhD, MPH; Bock, Naomi MD, MS; Walson, Judd MD, MPH§; Chaba, Linda MS*; Odek, James MBChB; McClelland, R. Scott MD, MPH§; Djomand, Gaston MD; Gao, Hongjiang PhD, MPH; John-Stewart, Grace MD, PhD, MPH§

doi: 10.1097/OLQ.0b013e31827aab89
Original Study

Background Identifying sexually transmitted infections (STI) in HIV-infected individuals has potential to benefit individual and public health. There are few guidelines regarding routine STI screening in sub-Saharan African HIV programs. We determined sexual risk behavior and prevalence and correlates of STI in a national survey of large HIV treatment programs in Kenya.

Methods A mobile screening team visited 39 (95%) of the 42 largest HIV care programs in Kenya and enrolled participants using population-proportionate systematic sampling. Participants provided behavioral and clinical data. Genital and blood specimens were tested for trichomoniasis, gonorrhea, chlamydia, syphilis, and CD4 T-lymphocyte counts.

Results Among 1661 adults, 41% reported no sexual partners in the past 3 months. Among those who reported sex in the past 3 months, 63% of women reported condom use during this encounter compared with 77% of men (P < 0.001). Trichomoniasis was the most common STI in women (10.9%) and men (2.8%); prevalences of gonorrhea, chlamydia, and syphilis were low (<1%–2%). Among women, younger age (adjusted odds ratio [OR], 0.96 per year; 95% confidence interval [CI], 0.94–0.98) and primary school education or lower level (adjusted OR, 2.16; 95% CI, 1.37–3.40) were independently associated with trichomoniasis, whereas CD4 count, cotrimoxazole use, and reported condom use were not. Reported condom use at last sex was associated with reporting that the clinic provided condoms among both women (OR, 1.7; 95% CI, 1.17–2.35) and men (OR, 2.4; 95% CI, 1.18–4.82).

Conclusions Women attending Kenyan HIV care programs had a 10.9% prevalence of trichomoniasis, suggesting that screening for this infection may be useful. Condom provision at clinics may enhance secondary HIV prevention efforts.

A national survey of sexually transmitted infection prevalence among adults enrolled in large HIV treatment programs in Kenya found a high prevalence of trichomoniasis among women.

From the *Kenya Medical Research Institute, Nairobi, Kenya; †Department of Epidemiology and Biostatistics, The George Washington University, Washington, DC; ‡US Centers for Disease Control and Prevention, Atlanta, GA; §Departments of Medicine, Epidemiology, and Global Health, University of Washington, Seattle, WA; and ¶Centers for Disease Control and Prevention Kenya, Nairobi, Kenya

The authors thank Jonathan Glick for creating the maps used in this manuscript.

Supported by the Centers for Disease Control and Prevention (U62/CCU024512) and the President’s Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention under the terms of cooperative agreement U62PS024512-05.

The authors state no conflicts of interest.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the US Centers for Disease Control and Prevention. The use of trade names is for identification purposes only and does not constitute endorsement by the US Centers for Disease Control and Prevention or the Department of Health and Human Services.

Sara Nelson Glick contributed equally to the manuscript.

Author contributions: Sara Nelson Glick, Benson Singa, Naomi Bock, and Grace John-Stewart conceptualized the present analysis. Sara Nelson Glick conducted the statistical analyses and wrote the manuscript. Grace John-Stewart and Naomi Bock conceptualized and designed the study and obtained funding. Benson Singa and Gaston Djomand designed study procedures, and Benson Singa oversaw field implementation of the study procedures. Judd Walson, James Odek, and R. Scott McClelland contributed to the design, conduct, and interpretation of study results. Linda Chaba and Hongjiang Gao provided data management and statistical analysis support. All authors contributed reviewed, edited, and approved the final version of this article.

Correspondence: Grace John-Stewart, MD, PhD, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359909, Seattle, WA 98104. E-mail:

Received for publication June 15, 2012, and accepted October 23, 2012.

© Copyright 2013 American Sexually Transmitted Diseases Association