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Risk Factors for Incidence of Sexually Transmitted Infections Among Women in a Human Immunodeficiency Virus Chemoprevention Trial: VOICE (MTN-003)

Chirenje, Zvavahera Mike MD, FRCOG; Gundacker, Holly M. MS; Richardson, Barbra PhD; Rabe, Lorna BS; Gaffoor, Zakir M Med Sci; Nair, Gonasagrie (Lulu) MBChB, MPH; Mirembe, Brenda Gati MBChB, MSc; Piper, Jeanna M. MD; Hillier, Sharon PhD; Marrazzo, Jeanne MD

Sexually Transmitted Diseases: March 2017 - Volume 44 - Issue 3 - p 135–140
doi: 10.1097/OLQ.0000000000000568
Original Study

Background 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.

Methods 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.

Results 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.

Conclusions 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.

In a subanalysis of data from the VOICE study, we observed high rates of incident sexually transmitted infections among women who were provided risk reduction counseling and condoms throughout the trial.

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

The authors are grateful to the research participants for their participation in their study. The authors would also like to thank the Microbicide Trials Network (MTN), the MTN-003 (VOICE) protocol team, all research site teams for sample and data collection.

Sources of Funding: The VOICE study (VOICE number, NCT00705679) was supported by MTN. MTN is funded by the National Institute of Allergy and Infectious Diseases (UM1AI068633, UM1AI068615, UM1AI106707), with co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health, all components of the U.S. National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflicts of Interest: None declared.

Correspondence: Zvavahera Mike Chirenje, MD, FRCOG, UZ-UCSF Collaborative Research Programme, 15 Philips Road, Belgravia, Harare, Zimbabwe. E-mail:

Received for publication May 18, 2016, and accepted November 9, 2016.

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