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. 2020 Jul 24;15(7):e0236501.
doi: 10.1371/journal.pone.0236501. eCollection 2020.

Prevalence and correlates of active syphilis and HIV co-Infection among sexually active persons aged 15-59 years in Zambia: Results from the Zambia Population-based HIV Impact Assessment (ZAMPHIA) 2016

Hiwote Solomon  1   2   3 , Albertina Ngomah Moraes  2   4 , Daniel B Williams  5 , Arlette Simo Fotso  6   7 , Yen T Duong  8 , Clement B Ndongmo  9 , Andrew C Voetsch  5 , Hetal Patel  5 , Kathryn Lupoli  5 , James B McAuley  10 , Gina Mulundu  11   12 , Webster Kasongo  13 , Lloyd Mulenga  2   11   12
Affiliations

Prevalence and correlates of active syphilis and HIV co-Infection among sexually active persons aged 15-59 years in Zambia: Results from the Zambia Population-based HIV Impact Assessment (ZAMPHIA) 2016

Hiwote Solomon et al. PLoS One. .

Abstract

Objectives: The main objectives of the study are to estimate HIV prevalence, active syphilis prevalence, and correlates of co-infection with HIV in Zambia, among recently sexually active individuals aged 15 to 59 years old.

Methods: We used data from the 2016 Zambia Population-based HIV Impact Assessment (ZAMPHIA), a national household survey that included biomarker testing for HIV and syphilis. Chembio DPP® Syphilis Screen and Confirm Assay was used to distinguish between active and older syphilis infections. This is the first time Chembio DPP® has been used in a national survey. Log-binominal modelling was utilized to understand the risk of acquiring HIV/active syphilis co-infection using select socio-demographic and sexual behavior variables. Multivariable analysis compared those with co-infection and those with no infection. All reported results account for the complex survey design and are weighted.

Results: A total of 19,114 individuals aged 15-59 years responded to the individual interview and had a valid syphilis and/or HIV test. The prevalence for those sexually active in the 12 months preceding ZAMPHIA 2016 was 3.5% and 13% for active syphilis and HIV, respectively. The prevalence of HIV/active syphilis co-infection was 1.5%. Factors associated with higher prevalence of co-infection versus no infection among females included, but were not limited to, those living in urban areas (adjusted prevalence ratio (aPR) = 3.0, 95% CI = 1.8, 4.8), those had sexual intercourse before age 15 years (aPR = 1.8, 95% CI = 1.1, 2.9), and those who had two or more sexual partners in the 12 months preceding the survey (aPR = 2.7, 95% CI = 1.6, 4.7).

Conclusion: These findings show high prevalence for both mono-infection with HIV and syphilis, as well as co-infection with HIV/active syphilis in Zambia. There is a need for better screening and partner services, particularly among those engaging in high-risk sexual behaviors (e.g., engaging in transactional sex).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. ZAMPHIA 2016 syphilis testing algorithm using Chembio Dual Path Platform (DPP) ® syphilis screen and confirm assay for screening.
*1,521 cases were referred for confirmatory testing using SD Bioline®.
Fig 2
Fig 2. ZAMPHIA 2016 syphilis testing algorithm using SD Bioline® Syphilis 3.0 antibody test for referrals to clinical facilities for treatment.
See this image and copyright information in PMC

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