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. 2025 Jul 10;16(1):1306.
doi: 10.4102/jphia.v16i1.1306. eCollection 2025.

Integrated HIV and STIs response: Trends in syphilis incidence and uptake of oral pre-exposure prophylaxis in Zambia

Kutha Banda  1   2 , Nicholus C Sande  3 , Chipwaila C Chunga  4 , Belia Longwe  1   2 , Kayawe Nkumbwa  5 , Madaliso Silondwa  1 , Nsanzya Maambo  6 , Japhet Michelo  1 , Prudence Haimbe  1 , Trevor Mwamba  7 , Hilda Shakwelele  1 , Sandra Chilengi-Sakala  6 , Ireen Bwalya  8
Affiliations

Integrated HIV and STIs response: Trends in syphilis incidence and uptake of oral pre-exposure prophylaxis in Zambia

Kutha Banda et al. J Public Health Afr. .

Abstract

Background: Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) was introduced in Zambia to prevent transmission, but it does not protect against sexually transmitted infections (STIs) such as syphilis. Globally, STIs have risen alongside PrEP rollout, posing significant public health concerns that require urgent attention and targeted intervention strategies.

Aim: We examined trends in syphilis incidence and assessed its association with PrEP use, given the increasing global burden of STIs, including among PrEP users between 2021 and 2023.

Setting: Among individuals in Zambia.

Methods: A retrospective database analysis of secondary data was conducted using District Health Information Software 2 (DHIS2), the Ministry of Health's primary data system. Microsoft® Excel and Stata were used for descriptive statistics and regression analysis to examine potential associations.

Results: From 2021 to 2023, syphilis cases (199 273) and PrEP initiation (436 460) increased annually. Syphilis cases rose from 22% to 46%, while PrEP initiation grew from 22% to 48%. We found a positive association between syphilis incidence and PrEP initiation, with each unit increase in PrEP initiation corresponding to a 0.33-unit rise in syphilis cases (p < 0.001; 95% confidence interval [CI]: 0.25-0.4), underscoring this relationship.

Conclusion: This analysis found a significant positive link between syphilis incidence and PrEP initiation, emphasising the need for integrated HIV and STI management to enhance public health interventions.

Contribution: This study provides valuable insights for policy and programme implications; it highlights the importance of integrating STI prevention into HIV prevention service delivery; an integrated approach is critical to ensure that the country does not regress the achievements made towards HIV epidemic control.

Keywords: incidence; pre-exposure prophylaxis; sexual health; syphilis; trend analysis.

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Conflict of interest statement

The author reported that they received funding from the Clinton Health Access Initiative through the STRIDE grant with funding from the Bill and Melinda Gates Foundation, which may be affected by the research reported in the enclosed publication. The author has disclosed those interests fully and has implemented an approved plan for managing any potential conflicts arising from their involvement. The terms of these funding arrangements have been reviewed and approved by the affiliated university in accordance with its policy on objectivity in research.

Figures

FIGURE 1
FIGURE 1
Trends in Syphilis incidence and pre-exposure prophylaxis initiation in Zambia (2021–2023).
FIGURE 2
FIGURE 2
Syphilis cases and pre-exposure prophylaxis initiation in Zambian health facilities (rural and urban health facilities) from 2021 to 2023.
FIGURE 3
FIGURE 3
Syphilis cases and pre-exposure prophylaxis initiation in rural health facilities in Zambia from 2021 to 2023.
FIGURE 4
FIGURE 4
Incidence and pre-exposure prophylaxis uptake in urban health facilities in Zambia from 2021 to 2023.
See this image and copyright information in PMC

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