Abstract

PIP: An intervention was conducted in the Mwanza Region of Tanzania to determine whether the improved treatment at rural health centers and dispensaries of sexually transmitted diseases (STD) other than HIV/AIDS could reduce the incidence of new HIV infections. Medical assistants and nurses in six rural health centers were trained in the syndromic management of STDs, and health center staff were encouraged to counsel their patients, offer them condoms, and ask for referrals of sex partners for treatment. The centers received the least expensive effective drugs for treating the major STD syndromes. Health workers trained as supervisors visited each center every 8 weeks to check drug supplies and patient records, provide refresher training, and ensure adherence to the syndromic management guidelines. Moreover, a cohort of 1000 adults in the communities served by the six health centers was interviewed and tested for HIV at the beginning of the study and 2 years after the intervention was introduced. The number of new cases of HIV infection occurring in the cohort was then compared with that occurring in another cohort selected from communities served by health centers where improved STD treatment had not been provided. 11,632 cases of STD were treated at the centers during the 2-year study period. It was determined that the intervention reduced by 42% the number of new HIV infections occurring over the study period. That reduction was across both sexes and all age groups, but evident especially among women aged 15-24 years. Survey results indicate that the reductions in HIV incidence were the result of improved STD treatment rather than changes in sexual behavior. Preliminary calculations indicate a cost of approximately US$300 per HIV infection averted.