The HIV and sexually transmitted infection syndemic following mass scale-up of combination HIV interventions in two communities in southern Uganda: a population-based cross-sectional study

M Kate Grabowski; Josephine Mpagazi; Stephen Kiboneka; Robert Ssekubugu; John Baptiste Kereba; Annet Nakayijja; Julius Tukundane; Jade C Jackson; Austin D Peer; Caitlin Kennedy; Godfrey Kigozi; Ronald M Galiwango; Yukari C Manabe; Larry W Chang; Sarah Kalibala; Ronald H Gray; Maria J Wawer; Steven J Reynolds; Aaron A R Tobian; David Serwadda; Charlotte A Gaydos; Joseph Kagaayi; Thomas C Quinn; Rakai Health Sciences Program

doi:10.1016/S2214-109X(22)00424-7

The HIV and sexually transmitted infection syndemic following mass scale-up of combination HIV interventions in two communities in southern Uganda: a population-based cross-sectional study

Lancet Glob Health. 2022 Dec;10(12):e1825-e1834. doi: 10.1016/S2214-109X(22)00424-7.

Authors

M Kate Grabowski¹, Josephine Mpagazi², Stephen Kiboneka², Robert Ssekubugu², John Baptiste Kereba², Annet Nakayijja², Julius Tukundane², Jade C Jackson³, Austin D Peer⁴, Caitlin Kennedy⁵, Godfrey Kigozi², Ronald M Galiwango², Yukari C Manabe⁶, Larry W Chang⁷, Sarah Kalibala², Ronald H Gray⁸, Maria J Wawer⁸, Steven J Reynolds⁹, Aaron A R Tobian¹⁰, David Serwadda¹¹, Charlotte A Gaydos⁶, Joseph Kagaayi¹², Thomas C Quinn⁹; Rakai Health Sciences Program

Collaborators

Rakai Health Sciences Program:
Dorean Nabukalu, Anthony Ndyanabo, Joseph Ssekasanvu, Hadijja Nakawooya, Jessica Nakukumba, Grace N Kigozi, Betty S Nantume, Nampijja Resty, Jedidah Kambasu, Margaret Nalugemwa, Regina Nakabuye, Lawrence Ssebanobe, Justine Nankinga, Adrian Kayiira, Gorreth Nanfuka, Ruth Ahimbisibwe, Stephen Tomusange, Ronald M Galiwango, Margaret Nakalanzi, Aisha Nalukwago, Joseph Ouma Otobi, Denis Ankunda, Joseph Lister Ssembatya, John Baptist Ssemanda, Robert Kairania, Emmanuel Kato, Alice Kisakye, James Batte, James Ludigo, Abisagi Nampijja, Steven Watya, Kighoma Nehemia, Sr Margaret Anyokot, Joshua Mwinike, George Kibumba, Paschal Ssebowa, George Mondo, Francis Wasswa, Agnes Nantongo, Rebecca Kakembo, Josephine Galiwango, Geoffrey Ssemango, Andrew D Redd, John Santelli, Oliver Laeyendecker, John Santelli, Jennifer Wagman, Rey Fernandez, Nelson Sewankambo, Yasmin Ogale

Affiliations

¹ Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Rakai Health Sciences Program, Kalisizo, Uganda. Electronic address: mgrabow2@jhu.edu.
² Rakai Health Sciences Program, Kalisizo, Uganda.
³ Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁴ Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Rakai Health Sciences Program, Kalisizo, Uganda.
⁶ Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁷ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Rakai Health Sciences Program, Kalisizo, Uganda; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁸ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Rakai Health Sciences Program, Kalisizo, Uganda.
⁹ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Rakai Health Sciences Program, Kalisizo, Uganda; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA; Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MA, USA.
¹⁰ Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹¹ Rakai Health Sciences Program, Kalisizo, Uganda; Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
¹² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.

Abstract

Background: Combination HIV prevention and treatment interventions (CHIs) have led to substantial declines in HIV incidence in sub-Saharan Africa; however, population-level data on non-HIV sexually transmitted infections (STIs) in the context of CHIs are rare. We aimed to assess STI burden following scale-up of CHIs in Uganda.

Methods: The Sexually Transmitted Infection Prevalence Study (STIPS) was a cross-sectional study nested within a population-based cohort among inland agrarian and Lake Victoria fishing populations in southern Uganda. STIPS enrolled consenting residents aged 18-49 years in two communities (one inland and one fishing) between May and October, 2019, and measured the prevalence of chlamydia, gonorrhoea, trichomonas, syphilis, and herpes simplex virus 2 (HSV-2).

Findings: Between May 27, 2019 and Oct 25, 2019, STIPS enrolled 1825 participants. HIV prevalence was 14·0% among the inland population and 39·8% among the fishing population, with about 90% HIV viral load suppression in both communities. Among inland and fishing populations, chlamydia prevalence was 9·6% (95% CI 7·9-11·7) and 9·9% (8·1-12·0), gonorrhoea prevalence 5·0% (3·8-6·7) and 8·4% (6·8-10·5), trichomonas prevalence 9·4% (7·7-11·5) and 12·2% (10·2-14·5), and HSV-2 prevalence 43·0% (39·9-46·3) and 64·4% (61·3-67·6), respectively. In the fishing population, syphilis seropositivity was 24·2% (21·5-27·2) with 9·4% (7·7-11·5) having high-titre (rapid plasma reagin ≥1:8) infection, including 16·9% (11·9-24·0%) of men living with HIV. Prevalence of at least one curable STI (chlamydia, gonorrhoea, trichomonas, or high-titre syphilis) was 51% higher among people living with HIV (vs HIV negative; adjusted prevalence risk ratio [PRR] 1·51; 95% CI 1·27-1·78), including among pregnant women (adjusted PRR 1·87, 1·11-3·17), with no differences by HIV suppression status.

Interpretation: Despite near universal HIV treatment, STI burden remains extremely high in southern Uganda, particularly among people living with HIV. There is an urgent need to integrate STI care with HIV services in African settings.

Funding: National Institutes of Health.

Publication types

Research Support, U.S. Gov't, P.H.S.
Research Support, N.I.H., Intramural
Research Support, N.I.H., Extramural

MeSH terms

Cross-Sectional Studies
Female
Gonorrhea*
HIV Infections* / epidemiology
HIV Infections* / prevention & control
Humans
Male
Pregnancy
Sexually Transmitted Diseases* / epidemiology
Sexually Transmitted Diseases* / prevention & control
Syndemic
Syphilis* / epidemiology
Trichomonas Infections*
Uganda / epidemiology
United States

Abstract

Publication types

MeSH terms

Grants and funding