A randomized, community trial of intensive sexually transmitted disease control for AIDS prevention, Rakai, Uganda

Maria J Wawer, Ronald H Gray, Nelson K. Sewankambo, David Serwadda, Lynn Paxton, Seth Berkley, Denise McNairn, Fred Wabwire-Mangen, Chuanjun Li, Fred Nalugoda, Noah Kiwanuka, Thomas Lutalo, Ronald Brookmeyer, Robert Kelly, Thomas C Quinn

Research output: Contribution to journalArticle

Abstract

Objective: To describe the design and first-round survey results of a trial of intensive sexually transmitted disease (STD) control to reduce HIV-1 incidence. Study design: Randomized, controlled, community-based trial in Rakai District, Uganda. Methods: In this ongoing study, 56 communities were grouped into 10 clusters designed to encompass social/sexual networks; clusters within blocks were randomly assigned to the intervention or control arm. Every 10 months, all consenting resident adults aged 15-59 years are visited in the home for interview and sample collection (serological sample, urine, and, in the case of women, self-administered vaginal swabs). Sera are tested for HIV-1, syphilis, gonorrhea, chlamydia, trichomonas and bacterial vaginosis. Following interview, all consenting adults are offered directly observed, single oral dose treatment (STD treatment in the intervention arm, anthelminthic and iron-folate in the control arm). Treatment is administered irrespective of symptoms or laboratory testing (mass treatment strategy). Both arms receive identical health education, condom and serological counseling services. Results: In the first home visit round, the study enrolled 5834 intervention and 5784 control arm subjects. Compliance with interview, sample collection and treatment was high in both arms (over 90%). Study arm populations were comparable with respect to sociodemographic and behavioral characteristics, and baseline HIV and STD rates. The latter were high: 16.9% of all subjects were HIV-positive, 10.0% had syphilis, and 23.8% of women had trichomonas and 50.9% had bacterial vaginosis. Conclusions: Testing the effects of STD control on AIDS prevention is feasible in this Ugandan setting.

Original languageEnglish (US)
Pages (from-to)1211-1225
Number of pages15
JournalAIDS
Volume12
Issue number10
DOIs
StatePublished - Jul 9 1998

Fingerprint

Uganda
Sexually Transmitted Diseases
Acquired Immunodeficiency Syndrome
Trichomonas
Bacterial Vaginosis
Interviews
Syphilis
HIV-1
HIV
Therapeutics
House Calls
Chlamydia
Gonorrhea
Condoms
Health Education
Folic Acid
Social Support
Counseling
Iron
Urine

Keywords

  • AIDS prevention
  • Randomized controlled trial
  • Sexually transmitted disease (STD) control
  • STD/HIV prevalence
  • STF mass treatment
  • Uganda

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

A randomized, community trial of intensive sexually transmitted disease control for AIDS prevention, Rakai, Uganda. / Wawer, Maria J; Gray, Ronald H; Sewankambo, Nelson K.; Serwadda, David; Paxton, Lynn; Berkley, Seth; McNairn, Denise; Wabwire-Mangen, Fred; Li, Chuanjun; Nalugoda, Fred; Kiwanuka, Noah; Lutalo, Thomas; Brookmeyer, Ronald; Kelly, Robert; Quinn, Thomas C.

In: AIDS, Vol. 12, No. 10, 09.07.1998, p. 1211-1225.

Research output: Contribution to journalArticle

Wawer, MJ, Gray, RH, Sewankambo, NK, Serwadda, D, Paxton, L, Berkley, S, McNairn, D, Wabwire-Mangen, F, Li, C, Nalugoda, F, Kiwanuka, N, Lutalo, T, Brookmeyer, R, Kelly, R & Quinn, TC 1998, 'A randomized, community trial of intensive sexually transmitted disease control for AIDS prevention, Rakai, Uganda', AIDS, vol. 12, no. 10, pp. 1211-1225. https://doi.org/10.1097/00002030-199810000-00014
Wawer, Maria J ; Gray, Ronald H ; Sewankambo, Nelson K. ; Serwadda, David ; Paxton, Lynn ; Berkley, Seth ; McNairn, Denise ; Wabwire-Mangen, Fred ; Li, Chuanjun ; Nalugoda, Fred ; Kiwanuka, Noah ; Lutalo, Thomas ; Brookmeyer, Ronald ; Kelly, Robert ; Quinn, Thomas C. / A randomized, community trial of intensive sexually transmitted disease control for AIDS prevention, Rakai, Uganda. In: AIDS. 1998 ; Vol. 12, No. 10. pp. 1211-1225.
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AU - Berkley, Seth

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AU - Wabwire-Mangen, Fred

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AU - Nalugoda, Fred

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N2 - Objective: To describe the design and first-round survey results of a trial of intensive sexually transmitted disease (STD) control to reduce HIV-1 incidence. Study design: Randomized, controlled, community-based trial in Rakai District, Uganda. Methods: In this ongoing study, 56 communities were grouped into 10 clusters designed to encompass social/sexual networks; clusters within blocks were randomly assigned to the intervention or control arm. Every 10 months, all consenting resident adults aged 15-59 years are visited in the home for interview and sample collection (serological sample, urine, and, in the case of women, self-administered vaginal swabs). Sera are tested for HIV-1, syphilis, gonorrhea, chlamydia, trichomonas and bacterial vaginosis. Following interview, all consenting adults are offered directly observed, single oral dose treatment (STD treatment in the intervention arm, anthelminthic and iron-folate in the control arm). Treatment is administered irrespective of symptoms or laboratory testing (mass treatment strategy). Both arms receive identical health education, condom and serological counseling services. Results: In the first home visit round, the study enrolled 5834 intervention and 5784 control arm subjects. Compliance with interview, sample collection and treatment was high in both arms (over 90%). Study arm populations were comparable with respect to sociodemographic and behavioral characteristics, and baseline HIV and STD rates. The latter were high: 16.9% of all subjects were HIV-positive, 10.0% had syphilis, and 23.8% of women had trichomonas and 50.9% had bacterial vaginosis. Conclusions: Testing the effects of STD control on AIDS prevention is feasible in this Ugandan setting.

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