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. 2019 Jan 18;19(1):87.
doi: 10.1186/s12889-019-6417-x.

Incidence rate of sexually transmitted infections among HIV infected patients on long-term ART in an urban and a rural clinic in Uganda

Stephen Okoboi  1   2   3 , Barbara Castelnuovo  4 , David M Moore  5   6 , Joseph Musaazi  4 , Andrew Kambugu  4 , Josephine Birungi  7 , Mastula Nanfuka  7 , Annelies Van Rie  8   9
Affiliations

Incidence rate of sexually transmitted infections among HIV infected patients on long-term ART in an urban and a rural clinic in Uganda

Stephen Okoboi et al. BMC Public Health. .

Abstract

Background: HIV immunosuppression increases susceptibility to other STIs and STIs can enhance HIV transmission, reduce CD4 cell count and increase viral load. Co-infections of HIV and STIs may thus reduce the preventive benefits of ART. Little is known about the incidence rate of STIs among long-term patients on ART.

Method: We conducted a secondary data analysis of all patients enrolled in a rural and an urban longitudinal cohort studies who initiated ART between April 2003 and July 2007 followed up to 2016. Patients were screened for STI every three months using "a syndromic and case management approaches". STI incidence rate, was defined as the number of new cases per population at risk over the follow-up review period. We performed a time-to-event and Kaplan Meier analysis. We used a multivariable Cox proportional hazards regression model to assess for factors associated with STI incidence.

Result: Of 1012 participants, 402 (39.8%) were urban and 610 (60.2%) rural residents. Mean age was 42.8 years (SD 8.5). The total number of follow up time was 44,304 person years. We observed STI incidence rate of 2.1 per 1000 person-years after follow-up. Rural residence (adjusted hazard ratio [aHR] 3.53, 95% CI: 1.95-6.39), younger age (aHR 2.05, 95% CI: 1.02-4.12 for 18-34 years and aHR 1.65, 95% CI: 1.00-2.72 for 35-44 years) were factors associated with higher incidence of STIs. Being male (aHR 0.51, 95% CI: 0.27-0.93) was associated with a lower incidence of STIs.

Conclusion: We found STIs incidence rate of approximately 3 per 1000 person-years among patients on long-term (≥ 4 years) ART followed up-to 3.5 years. Rural and younger persons on ART should be routinely screened for STIs because high incidence of STIs may undo the preventative effects of ART for all.

Keywords: And sexual behavior; Anti-retroviral therapy; Incidence rate; Sexually transmitted infection.

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Conflict of interest statement

Ethics approval and consent to participate

The IDI urban cohort study was approved by the Makerere University School of Medicine IRB and the Uganda National Council for Science and Technology.

The Long-Term Outcomes on ART in Uganda was approved by the Research Ethics committee of TASO, the Science and Ethics Committee of the Uganda Virus Research Institute, the Uganda National Council for Science and Technology and the Research Ethics Board of the University of British Columbia. All participants provided written informed consent. Senior management of TASO and IDI approved data access as per their respective institutional data access and sharing policies.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart showing urban and rural cohort participants follow up information. This figures shows the flow chart of the cohorts participants
Fig. 2
Fig. 2
Kaplan-Meier failure plot for cumulative probability of having sexually transmitted infection. In this figure, we observed a significant difference and higher STI incidence over 3.5 years of follow-up in the rural participants compared to the urban participants
See this image and copyright information in PMC

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